MEDICARE: FAMILY MEDICAL CENTER OF MICHIGAN,INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1679195721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CENTER OF MICHIGAN,INC

Provider Business Mailing Address
First Line	:	8765 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9300
Country	:	US
Telephone Number	:	734-850-6903
Fax Number	:	734-850-0520

Provider Business Practice Location Address
First Line	:	2740 COLLINGWOOD ST STE 100
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1473
Country	:	US
Telephone Number	:	734-654-2169
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHRISTINE CROLEY
Credential	:
Telephone Number	:	734-850-6915

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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