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General NPI Number Information
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NPI Number | 1578568036
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EMERGENCY CARE, P.C.
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 18101 OAKWOOD BLVD EMERGENCY MEDICINE DEPARTMENT
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City | DEARBORN
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State | MI
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Zip | 48124-4089
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Country | US
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Telephone | 313-593-8780
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Fax | 888-861-8740
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Provider Business Mailing Address
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Address Line | 38935 ANN ARBOR RD
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City | LIVONIA
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State | MI
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Zip | 48150-3354
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Country | US
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Telephone | 734-632-0175
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Fax | 888-861-8740
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Authorized Official
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Title or Position | CMO
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Name | JOHN BAUER
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Credential | MD
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Telephone | 734-632-0175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | MI
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