MEDICARE: MED CARE CLINIC LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1497997068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	28930 GREENING ST
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2985
Country	:	US
Telephone Number	:	248-996-5025
Fax Number	:

Provider Business Practice Location Address
First Line	:	16315 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1825
Country	:	US
Telephone Number	:	248-996-5025
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SAMEER SHRIRAM BHAGWAT
Credential	:
Telephone Number	:	248-996-5025

Provider Enumeration Date	:	03/29/2009
Last Update Date	:	03/29/2009

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