Healthcare Provider Details

I. General information

NPI: 1942309091
Provider Name (Legal Business Name): PLUMBROOK MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39880 VAN DYKE STE 102
STERLING HGHTS MI
48313
US

IV. Provider business mailing address

39880 VAN DYKE STE 102
STERLING HGHTS MI
48313
US

V. Phone/Fax

Practice location:
  • Phone: 586-939-9060
  • Fax: 586-939-6639
Mailing address:
  • Phone: 586-939-9060
  • Fax: 586-939-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFN009587
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLN004676
License Number StateMI

VIII. Authorized Official

Name: DR. FREDRIC I NEUMANN
Title or Position: PRESIDENT
Credential: DO
Phone: 586-939-9060