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General NPI Number Information
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NPI Number | 1194940627
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Entity Type | Organization
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Legal Business Name | MICHIGAN FAMILY PHYSICIANS, PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 400 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-3628
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Country | US
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Telephone | 734-522-7000
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Fax | 734-522-7012
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Provider Business Mailing Address
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Address Line | 400 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-3628
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Country | US
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Telephone | 734-522-7000
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Fax | 734-522-7012
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. THERESA L PLESCO
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Credential |
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Telephone | 734-522-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101014641
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704136023
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101009187
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License Number State | MI
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