Healthcare Provider Details

I. General information

NPI: 1053461848
Provider Name (Legal Business Name): TRUST CARE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST LOWR LEVEL SUITE B
WEST BRANCH MI
48661-9390
US

IV. Provider business mailing address

611 COURT ST LOWR LEVEL PO BOX 903
WEST BRANCH MI
48661-9390
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-2068
  • Fax:
Mailing address:
  • Phone: 989-345-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301079461
License Number StateMI

VIII. Authorized Official

Name: HATEM M ATAYA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 989-345-2068