=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770448920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCLAREN COMMUNITY BASED PRIMARY CARE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6815 DIXIE HWY STE 3
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48346-2092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-384-8300
-----------------------------------------------------
Fax | 248-384-8301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | G3235 BEECHER RD STE B
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | BINESH PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-342-1041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------