Provider Demographics
NPI:1487966206
Name:FAMILY MEDICINE ASSOCIATES OF MACOMB PC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF MACOMB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-465-2000
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-1330
Mailing Address - Country:US
Mailing Address - Phone:586-465-2000
Mailing Address - Fax:586-465-2002
Practice Address - Street 1:21250 HALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-7232
Practice Address - Country:US
Practice Address - Phone:586-465-2000
Practice Address - Fax:586-465-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMN079004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E03109OtherBCBS
MII31814Medicare UPIN
MII47431Medicare UPIN
MIMI3659Medicare PIN
MI6523360001Medicare NSC