MEDICARE: PLATINUM PRIMARY CARE, PLLC

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	:	1124973052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM PRIMARY CARE, PLLC

Provider Business Mailing Address
First Line	:	23420 FORD RD STE 100
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2396
Country	:	US
Telephone Number	:	313-203-5310
Fax Number	:	313-914-2529

Provider Business Practice Location Address
First Line	:	23420 FORD RD STE 100
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2396
Country	:	US
Telephone Number	:	313-203-5310
Fax Number	:	313-914-2529

Authorized Official
Title or Position	:	C.O.O.
Name	:	ERIC ALZAROUI
Credential	:
Telephone Number	:	313-203-5300

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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