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General NPI Number Information
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NPI Number | 1487966206
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE ASSOCIATES OF MACOMB PC
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 21250 HALL RD SUITE 200
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City | CLINTON TWP
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State | MI
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Zip | 48038-7232
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Country | US
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Telephone | 586-465-2000
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Fax | 586-465-2002
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Provider Business Mailing Address
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Address Line | PO BOX 1330
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City | STERLING HEIGHTS
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State | MI
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Zip | 48311-1330
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Country | US
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Telephone | 586-465-2000
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Fax | 586-465-2002
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANHAL NAOUMI
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Credential | MD
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Telephone | 586-465-2000
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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 | MN079004
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License Number State | MI
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