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General NPI Number Information
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NPI Number | 1235438425
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Entity Type | Organization
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Legal Business Name | DOWNRIVER FAMILY CARE
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 26375 ALLEN RD
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City | WOODHAVEN
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State | MI
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Zip | 48183-4352
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Country | US
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Telephone | 734-775-2796
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Fax | 734-362-0603
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Provider Business Mailing Address
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Address Line | 26375 ALLEN RD
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City | WOODHAVEN
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State | MI
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Zip | 48183-4352
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Country | US
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Telephone | 734-775-2796
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Fax | 734-362-0603
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN BARDEN
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Credential | DO
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Telephone | 734-775-2796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101006701
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License Number State | MI
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