Healthcare Provider Details

I. General information

NPI: 1255963401
Provider Name (Legal Business Name): METROCARE VISITING PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 CROOKS RD STE 108
TROY MI
48098-2818
US

IV. Provider business mailing address

3785 BAY RD
SAGINAW MI
48603-2433
US

V. Phone/Fax

Practice location:
  • Phone: 248-353-6200
  • Fax:
Mailing address:
  • Phone: 989-791-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN HAYES
Title or Position: CEO
Credential:
Phone: 586-321-6569