MEDICARE: MACOMB FAMILY SERVICES, 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	251C00000X	Developmentally Disabled Services Day Training Agency		MI
2	103TC0700X	Clinical Psychologist	N/A	MI
3	2084P0800X	Psychiatry Physician	N/A	MI
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125267	OTHER	MI	VALUE OPTIONS PIN # - ALL
2	20389	OTHER	MI	BLUE CROSS S/A
3	2066282	OTHER	MI	ROMEO CIGNA PIN #
4	2068754	OTHER	MI	RICHMOND CIGNA PIN #
5	750910529	OTHER	MI	ROMEO BLUE CROSS PIN #
6	750910671	OTHER	MI	SHELBY BLUE CROSS PIN #
7	20531	OTHER	MI	BLUE CROSS S/A
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	13305	OTHER	MI	CLINTON CIGNA PIN #
10	750910710	OTHER	MI	BLUE CROSS BLUE SHIELD
11	20528	OTHER	MI	BLUE CROSS S/A
12	750910612	OTHER	MI	CLINTON BLUE CROSS PIN #
13	M07925	OTHER	MI	HAP PIN #- ALL SITES
14	20572	OTHER	MI	BLUE CROSS S/A
15	750910526	OTHER	MI	RICHMOND BLUE CROSS PIN #
16	77353	OTHER	MI	SHELBY CIGNA PIN #

General Provider Information

NPI Number	:	1831190701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACOMB FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	36975 UTICA RD
Second Line	:	SUITE 103
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-1685
Country	:	US
Telephone Number	:	586-226-3440
Fax Number	:	586-226-3672

Provider Business Practice Location Address
First Line	:	36975 UTICA RD
Second Line	:	SUITE 103
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-1685
Country	:	US
Telephone Number	:	586-226-3440
Fax Number	:	586-226-3740

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	OWEN PFAENDTNER
Credential	:
Telephone Number	:	586-336-0422

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/28/2017

Similar Medicare Providers

1538257688 — MAJID PEZHMAN MD
Practice Location Address:

36975 UTICA RD , SUITE 104
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-226-3440
Practice Fax: 586-226-3740

1649341850 — MRS. RENEE CANNON M.A., L.P.C.
Practice Location Address:

36975 UTICA RD , SUITE 104
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-226-3440
Practice Fax: 586-226-3740

1083780498 — OWEN PFAENDTNER MSW, CSW
Practice Location Address:

36975 UTICA RD , SUITE 104
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-226-3440
Practice Fax: 586-226-3740

1649338534 — LISE A SHIRTZ PH.D.
Practice Location Address:

36975 UTICA RD , SUITE 103
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-226-3440
Practice Fax: 586-226-3740

1396913893 — ASCENSION MEDICAL GROUP MICHIGAN
Practice Location Address:

36975 UTICA RD , SUITE 102
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-228-0500
Practice Fax: 586-228-3865

1144519547 — ROBYN N LENTZ LMSW
Practice Location Address:

36975 UTICA RD , SUITE 100
CLINTON TOWNSHIP, MI
48036-1685

Practice Phone: 586-226-3440
Practice Fax: 586-226-8820

Directions to “MACOMB FAMILY SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.