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General NPI Number Information
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NPI Number | 1538222823
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Entity Type | Organization
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Legal Business Name | GENESEE FAMILY CARE PC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 3020 SOUTH GENESEE RD
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City | BURTON
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State | MI
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Zip | 48519
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Country | US
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Telephone | 810-715-3049
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Fax | 810-744-2850
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Provider Business Mailing Address
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Address Line | 3020 SOUTH GENESEE RD
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City | BURTON
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State | MI
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Zip | 48519
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Country | US
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Telephone | 810-715-3049
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Fax | 810-744-2850
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOSE B LOPEZ
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Credential | MD
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Telephone | 810-715-3049
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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 | MO079826
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License Number State | MI
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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 | JL047858
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License Number State | MI
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