Healthcare Provider Details

I. General information

NPI: 1265713242
Provider Name (Legal Business Name): MEDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 E 12 MILE RD
WARREN MI
48092-5644
US

IV. Provider business mailing address

2243 E 12 MILE RD
WARREN MI
48092-5644
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8100
  • Fax: 586-573-8101
Mailing address:
  • Phone: 586-573-8100
  • Fax: 586-573-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301093657
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301009328
License Number StateMI

VIII. Authorized Official

Name: JOHN PISPIDIKIS
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 586-573-8100