Healthcare Provider Details

I. General information

NPI: 1073467908
Provider Name (Legal Business Name): COREMED PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 HIGHLAND RD
WHITE LAKE MI
48386-4618
US

IV. Provider business mailing address

8355 HIGHLAND RD
WHITE LAKE MI
48386-4618
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-6005
  • Fax: 833-450-0167
Mailing address:
  • Phone: 248-666-6005
  • Fax: 833-450-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAAN EKKAH
Title or Position: OWNER
Credential:
Phone: 332-330-3903