Healthcare Provider Details

I. General information

NPI: 1194806745
Provider Name (Legal Business Name): BICOUNTY MEDICAL PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30205 SCHOENHERR RD STE B
WARREN MI
48088-6800
US

IV. Provider business mailing address

30205 SCHOENHERR RD STE B
WARREN MI
48088-6800
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-9966
  • Fax: 586-558-5534
Mailing address:
  • Phone: 586-558-9966
  • Fax: 586-558-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE COLOMINA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 586-558-5237