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General NPI Number Information
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NPI Number | 1558761866
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Entity Type | Organization
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Legal Business Name | NEW FAITH MEDICAL CENTER
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 28200 7 MILE RD SUITE 207
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City | LIVONIA
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State | MI
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Zip | 48152-3794
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Country | US
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Telephone | 313-539-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 28200 7 MILE RD SUITE 207
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City | LIVONIA
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State | MI
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Zip | 48152-3794
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Country | US
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Telephone | 313-539-4840
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KAMITKO MOORE
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Credential |
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Telephone | 313-539-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801092021
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601002272
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301043030
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License Number State | MI
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