MEDICARE: FARMINGTON FAMILY PHYSICIANS PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205898590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMINGTON FAMILY PHYSICIANS PC

Provider Business Mailing Address
First Line	:	23800 ORCHARD LAKE ROAD
Second Line	:	STE 100
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-2561
Country	:	US
Telephone Number	:	248-476-2420
Fax Number	:	248-476-9709

Provider Business Practice Location Address
First Line	:	23800 ORCHARD LAKE ROAD
Second Line	:	STE 100
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-2561
Country	:	US
Telephone Number	:	248-476-2420
Fax Number	:	248-476-9709

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY C MUNACO
Credential	:	MD
Telephone Number	:	248-476-2420

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/22/2020

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