Healthcare Provider Details

I. General information

NPI: 1194940627
Provider Name (Legal Business Name): MICHIGAN FAMILY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WAYNE RD
WESTLAND MI
48185-3628
US

IV. Provider business mailing address

400 N WAYNE RD
WESTLAND MI
48185-3628
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-7000
  • Fax: 734-522-7012
Mailing address:
  • Phone: 734-522-7000
  • Fax: 734-522-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101014641
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704136023
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009187
License Number StateMI

VIII. Authorized Official

Name: MS. THERESA L PLESCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 734-522-7000