MEDICARE: PLUMBROOK MEDICAL CENTER 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	207Q00000X	Family Medicine Physician	LN004676	MI
2	207Q00000X	Family Medicine Physician	FN009587	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080082386	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080E01042	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	23D0371615	OTHER	MI	CLIA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	43253579	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1942309091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUMBROOK MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	39880 VAN DYKE
Second Line	:	STE 102
City	:	STERLING HGHTS
State	:	MI
Zip	:	48313
Country	:	US
Telephone Number	:	586-939-9060
Fax Number	:	586-939-6639

Provider Business Practice Location Address
First Line	:	39880 VAN DYKE
Second Line	:	STE 102
City	:	STERLING HGHTS
State	:	MI
Zip	:	48313
Country	:	US
Telephone Number	:	586-939-9060
Fax Number	:	586-939-6639

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDRIC I NEUMANN
Credential	:	DO
Telephone Number	:	586-939-9060

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/07/2023

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Directions to “PLUMBROOK MEDICAL CENTER PC ” Practice Location

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