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General NPI Number Information
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NPI Number | 1376601179
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST HEALTH CARE CAPAC PLLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 117 S MAIN ST
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City | CAPAC
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State | MI
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Zip | 48014-3715
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Country | US
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Telephone | 810-395-4840
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Fax | 810-395-7551
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Provider Business Mailing Address
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Address Line | 117 S MAIN ST
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City | CAPAC
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State | MI
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Zip | 48014-3715
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Country | US
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Telephone | 810-395-4840
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Fax | 810-395-7551
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOREN J DECARLO
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Credential | D.O.
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Telephone | 810-395-4840
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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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