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General NPI Number Information
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NPI Number | 1558759183
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE MEDICINE, PC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 14272 N FENTON RD
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City | FENTON
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State | MI
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Zip | 48430-1544
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Country | US
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Telephone | 810-714-5100
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Fax | 810-714-5101
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Provider Business Mailing Address
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Address Line | 8359 OFFICE PARK DR SUITE B
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City | GRAND BLANC
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State | MI
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Zip | 48439-2078
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Country | US
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Telephone | 810-266-0206
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MS. ZINA BACHUWA
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Credential |
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Telephone | 810-266-0206
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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