Healthcare Provider Details

I. General information

NPI: 1225692387
Provider Name (Legal Business Name): INTEGRATIVE FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52915 MOUND RD
SHELBY TOWNSHIP MI
48316-3266
US

IV. Provider business mailing address

11256 ORCHARD HILL DR
BRUCE TWP MI
48065-4397
US

V. Phone/Fax

Practice location:
  • Phone: 586-210-3200
  • Fax: 586-210-3300
Mailing address:
  • Phone: 586-709-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA A MUNN
Title or Position: PA., OWNER, AUTHORIZED OFFICIAL
Credential: PA
Phone: 586-709-5271