Healthcare Provider Details

I. General information

NPI: 1548177983
Provider Name (Legal Business Name): PRIMUCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 W BIG BEAVER RD STE 510
TROY MI
48084-2917
US

IV. Provider business mailing address

3290 W BIG BEAVER RD STE 510
TROY MI
48084-2917
US

V. Phone/Fax

Practice location:
  • Phone: 734-513-3731
  • Fax:
Mailing address:
  • Phone: 734-513-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: WILMAR SUAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 734-513-2731