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General NPI Number Information
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NPI Number | 1205271244
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Entity Type | Organization
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Legal Business Name | FAMILY CARE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 30785 STEPHENSON HWY
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-1618
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Country | US
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Telephone | 248-439-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 30785 STEPHENSON HWY
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-1618
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Country | US
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Telephone | 248-439-2190
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ERICA MCEVOY
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Credential |
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Telephone | 248-541-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | MI
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