Healthcare Provider Details

I. General information

NPI: 1194234120
Provider Name (Legal Business Name): PRIME MOBILE CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 W 9 MILE RD STE 375
SOUTHFIELD MI
48075-4404
US

IV. Provider business mailing address

17515 W 9 MILE RD STE 375
SOUTHFIELD MI
48075-4404
US

V. Phone/Fax

Practice location:
  • Phone: 248-450-3942
  • Fax: 248-450-3946
Mailing address:
  • Phone: 248-450-3942
  • Fax: 248-450-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. GENENE MARGIT ESTRADA
Title or Position: OWNER
Credential:
Phone: 248-450-3942