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General NPI Number Information
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NPI Number | 1346690245
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Entity Type | Organization
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Legal Business Name | GOLDEN FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 23463 E SCOTT BLVD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-3155
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Country | US
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Telephone | 734-945-0482
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Fax |
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Provider Business Mailing Address
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Address Line | 23463 E SCOTT BLVD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-3155
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Country | US
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Telephone | 734-945-0482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDI NICOLE BASKET
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Credential | DO
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Telephone | 734-945-0482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 510108586
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License Number State | MI
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