Healthcare Provider Details

I. General information

NPI: 1174693097
Provider Name (Legal Business Name): MICHIGAN ADULT & CHILD MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 COMMON ROAD SUITE 200
WARREN MI
48093
US

IV. Provider business mailing address

8545 COMMON ROAD SUITE 200
WARREN MI
48093
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-0732
  • Fax: 586-751-3822
Mailing address:
  • Phone: 586-751-0732
  • Fax: 586-751-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTA LOUISE BELBOT
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-751-0732