Healthcare Provider Details

I. General information

NPI: 1629785837
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER OF MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

V. Phone/Fax

Practice location:
  • Phone: 734-654-2169
  • Fax:
Mailing address:
  • Phone: 734-654-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY TERRILL
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 517-263-1800