MEDICARE: NORTH MACOMB FAMILY PRACTICE, P.C.

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	5101013932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0855011334	OTHER	MI	BLUECROSS/BLUESHIELD PIN
2	24033	OTHER	MI	HEALTH PLAN OF MICHIGAN P
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	148005	OTHER	MI	GREAT LAKES ID NUMBER

General Provider Information

NPI Number	:	1235118076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH MACOMB FAMILY PRACTICE, P.C.

Provider Business Mailing Address
First Line	:	48762 GRATIOT AVE
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2675
Country	:	US
Telephone Number	:	586-421-1075
Fax Number	:	586-421-1085

Provider Business Practice Location Address
First Line	:	48762 GRATIOT AVE
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2675
Country	:	US
Telephone Number	:	586-421-1075
Fax Number	:	586-421-1085

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW D ADAIR
Credential	:	D.O.
Telephone Number	:	586-421-1075

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/22/2020

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Directions to “NORTH MACOMB FAMILY PRACTICE, P.C. ” Practice Location

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