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General NPI Number Information
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NPI Number | 1639385784
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Entity Type | Organization
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Legal Business Name | PHYSICIAN HEALTHCARE NETWORK, PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 4190 24TH AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3882
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Country | US
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Telephone | 810-989-7770
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Fax | 810-989-7760
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Provider Business Mailing Address
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Address Line | 3050 COMMERCE DR
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3819
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Country | US
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Telephone | 810-385-4441
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Fax | 810-385-4933
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MIMMA CUSUMANO
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Credential |
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Telephone | 810-385-8081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | MI
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