Healthcare Provider Details

I. General information

NPI: 1770819864
Provider Name (Legal Business Name): MIDWEST FAMILY PRACTICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 E 12 MILE RD
WARREN MI
48093-3520
US

IV. Provider business mailing address

12640 E 12 MILE RD
WARREN MI
48093-3520
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-2020
  • Fax: 586-751-7872
Mailing address:
  • Phone: 586-751-2020
  • Fax: 586-751-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: SAM H AWADA
Title or Position: OWNER
Credential: M.D.
Phone: 586-751-2020