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General NPI Number Information
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NPI Number | 1104931211
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Entity Type | Organization
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Legal Business Name | GLADWIN FAMILY CARE CENTER P C
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 2137 W M61
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City | GLADWIN
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State | MI
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Zip | 48624
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Country | US
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Telephone | 989-426-9399
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Fax | 989-246-2257
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Provider Business Mailing Address
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Address Line | 3061 CHRISTY WAY
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City | SAGINAW
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State | MI
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Zip | 48603-2267
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | PRESIDENT
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Name | HICHAM CHURBAJI
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Credential | MD
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Telephone | 989-426-9399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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