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General NPI Number Information
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NPI Number | 1104253111
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PHYSICIAN NETWORK P C
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 4136 LEGACY PKWY SUITE 110
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City | LANSING
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State | MI
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Zip | 48911-4265
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Country | US
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Telephone | 517-206-1388
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Fax |
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Provider Business Mailing Address
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Address Line | 2843 E GRAND RIVER AVE BOX 260
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City | EAST LANSING
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State | MI
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Zip | 48823-6722
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Country | US
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Telephone | 517-206-1388
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ASHER JAVAID BASHIR
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Credential | J.D.
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Telephone | 517-206-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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