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General NPI Number Information
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NPI Number | 1487349510
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Entity Type | Organization
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Legal Business Name | PATIENT CENTERED FAMILY MEDICINE & OMT
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 9960 VILLAGE PLACE BLVD
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City | BRIGHTON
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State | MI
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Zip | 48116-2089
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Country | US
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Telephone | 248-869-6500
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Fax | 248-869-6509
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Provider Business Mailing Address
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Address Line | 55275 8 MILE RD
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City | NORTHVILLE
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State | MI
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Zip | 48167-9158
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Country | US
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Telephone | 248-924-4884
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. THERESA RENEA ANDERSONNING
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Credential | DO
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Telephone | 248-924-4884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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