MEDICARE: C & M VISITING PHYSICIANS PLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144240458	OTHER	MI	JOHN MCCOLLOUGH MD
2	1770553521	OTHER	MI	ALPHONSO BERRY MD
3	110H211060	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1487723771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & M VISITING PHYSICIANS PLC

Provider Business Mailing Address
First Line	:	2990 W GRAND BLVD
Second Line	:	SUITE 408
City	:	DETROIT
State	:	MI
Zip	:	48202-3041
Country	:	US
Telephone Number	:	313-874-4436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 W GRAND BLVD
Second Line	:	SUITE 408
City	:	DETROIT
State	:	MI
Zip	:	48202-3041
Country	:	US
Telephone Number	:	313-874-4436
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHARLES MCRAE
Credential	:
Telephone Number	:	313-874-4436

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/12/2009

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