Healthcare Provider Details

I. General information

NPI: 1952573248
Provider Name (Legal Business Name): HOLY FAMILY CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E CUMMINS ST
TECUMSEH MI
49286-2074
US

IV. Provider business mailing address

502 E CUMMINS ST
TECUMSEH MI
49286-2074
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-5508
  • Fax: 517-423-4772
Mailing address:
  • Phone: 517-423-5508
  • Fax: 517-423-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301073146
License Number StateMI

VIII. Authorized Official

Name: DR. MARIA ADELA ASIS CORDOBA-NAUGIT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 517-423-5508