Healthcare Provider Details

I. General information

NPI: 1568858504
Provider Name (Legal Business Name): AMD PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7070 MILLER RD SUITE A
SWARTZ CREEK MI
48473-1591
US

IV. Provider business mailing address

7070 MILLER RD SUITE A
SWARTZ CREEK MI
48473
US

V. Phone/Fax

Practice location:
  • Phone: 810-564-7995
  • Fax:
Mailing address:
  • Phone: 810-564-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL A MASSIMINO
Title or Position: COO
Credential:
Phone: 810-564-7998