Healthcare Provider Details

I. General information

NPI: 1457716102
Provider Name (Legal Business Name): COLUMBIAVILLE FAMILY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MCLEOD DR N STE A
SAGINAW MI
48604-2857
US

IV. Provider business mailing address

2575 MCLEOD DR N
SAGINAW MI
48604-2857
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-5532
  • Fax: 989-797-5537
Mailing address:
  • Phone: 989-797-5532
  • Fax: 989-797-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301059644
License Number StateMI

VIII. Authorized Official

Name: NAVEED MAHFOOZ
Title or Position: OWNER
Credential: MD
Phone: 989-672-2100