Healthcare Provider Details

I. General information

NPI: 1265876841
Provider Name (Legal Business Name): HOUSECALL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 EUREKA RD SUITE 709
TAYLOR MI
48180-5343
US

IV. Provider business mailing address

20600 EUREKA RD SUITE 709
TAYLOR MI
48180-5343
US

V. Phone/Fax

Practice location:
  • Phone: 269-274-9943
  • Fax:
Mailing address:
  • Phone: 269-274-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301090976
License Number StateMI

VIII. Authorized Official

Name: SUBRAMANIAM K RANGAN
Title or Position: MANAGER
Credential:
Phone: 269-274-9943