Healthcare Provider Details

I. General information

NPI: 1538590583
Provider Name (Legal Business Name): ROCHESTER FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 W AUBURN RD
ROCHESTER HILLS MI
48309-4386
US

IV. Provider business mailing address

1308 W AUBURN RD
ROCHESTER HILLS MI
48309-4386
US

V. Phone/Fax

Practice location:
  • Phone: 248-915-5949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301089681
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301089681
License Number StateMI

VIII. Authorized Official

Name: DR. TAHERA AZHARUDDIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-915-5949