=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487775417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT PRIMARY CARE ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 10/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8896 COMMERCE RD STE 4
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48382-4494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-360-6600
-----------------------------------------------------
Fax | 248-360-6601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8896 COMMERCE RD STE 4
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48382-4494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-360-6600
-----------------------------------------------------
Fax | 248-360-6601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/HEATHCARE PROVIDER OF ADULT P
-----------------------------------------------------
Name | CYNTHIA R DISKIN
-----------------------------------------------------
Credential | DNP, APN-BC
-----------------------------------------------------
Telephone | 248-360-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4704136302
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------