MEDICARE: PRIMARY MEDICINE 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1427625292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MEDICINE PC

Provider Business Mailing Address
First Line	:	5045 CHARING CROSS RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 CHARING CROSS RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-3681
Country	:	US
Telephone Number	:	248-953-0526
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	GHAZALA KHAN
Credential	:
Telephone Number	:	734-693-4011

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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