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General NPI Number Information
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NPI Number | 1235281916
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Entity Type | Organization
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Legal Business Name | PRIMECARE OF NOVI PLLC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 39555 WEST TEN MILE RD SUITE 302
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City | NOVI
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State | MI
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Zip | 48375-2950
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Country | US
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Telephone | 248-426-7200
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Fax | 248-426-7335
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Provider Business Mailing Address
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Address Line | 39555 WEST TEN MILE RD SUITE 302
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City | NOVI
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State | MI
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Zip | 48375-2950
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Country | US
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Telephone | 248-426-7200
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Fax | 248-426-7335
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Authorized Official
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Title or Position | MEMBER
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Name | THEODORE W SHIVELY
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Credential | D.O.
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Telephone | 248-426-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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