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General NPI Number Information
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NPI Number | 1669521746
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Entity Type | Organization
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Legal Business Name | PREFERRED FAMILY MEDICINE PC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1200 W 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-4439
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Country | US
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Telephone | 248-543-0600
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Fax | 248-543-0562
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Provider Business Mailing Address
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Address Line | 1200 W 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-4439
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Country | US
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Telephone | 248-543-0600
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Fax | 248-543-0562
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. MARC F WEISMAN
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Credential | D.O,
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Telephone | 248-543-0600
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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 | MW008700
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License Number State | MI
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