MEDICARE: PRIME CARE MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1013969047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	22150 GREENFIELD RD
Second Line	:	SUITE 100
City	:	OAK PARK
State	:	MI
Zip	:	48237-2535
Country	:	US
Telephone Number	:	248-967-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	22150 GREENFIELD RD
Second Line	:	SUITE 100
City	:	OAK PARK
State	:	MI
Zip	:	48237-2535
Country	:	US
Telephone Number	:	248-967-5882
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANAA GHAZI
Credential	:
Telephone Number	:	248-967-5882

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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