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General NPI Number Information
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NPI Number | 1366509523
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Entity Type | Organization
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Legal Business Name | CAPAC MEDICAL CENTER PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4316 CAPAC ROAD
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City | CAPAC
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State | MI
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Zip | 48014
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Country | US
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Telephone | 810-395-4375
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Fax | 810-395-4238
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Provider Business Mailing Address
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Address Line | 4316 CAPAC ROAD
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City | CAPAC
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State | MI
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Zip | 48014
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Country | US
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Telephone | 810-395-4375
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Fax | 810-395-4238
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. PHILIP MILAN MATICH
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Credential | MD
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Telephone | 810-395-4375
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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 | PM 406642
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License Number State | MI
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