MEDICARE: FAMILY MEDICAL CENTER OF MICHIGAN, 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1154892958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CENTER OF MICHIGAN, INC

Provider Business Mailing Address
First Line	:	8765 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9583
Country	:	US
Telephone Number	:	734-850-6903
Fax Number	:	734-850-0520

Provider Business Practice Location Address
First Line	:	2425 TUXEDO ST RM 115
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1222
Country	:	US
Telephone Number	:	734-654-2169
Fax Number	:	734-654-2535

Authorized Official
Title or Position	:	CEO
Name	:	ED LARKINS
Credential	:
Telephone Number	:	734-850-6915

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	09/22/2020

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