Basic Information
Provider Information
NPI: 1073705083
EntityType: 2
ReplacementNPI:  
OrganizationName: AMERICAN CURRENT CARE OF MICHIGAN PC
LastName:  
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Mailing Information
Address1: 5080 SPECTRUM DRIVE
Address2: SUITE 1200 WEST
City: ADDISON
State: TX
PostalCode: 750014625
CountryCode: US
TelephoneNumber: 8002323550
FaxNumber:  
Practice Location
Address1: 40732 VAN DYKE ROAD
Address2:  
City: STERLING HEIGHTS
State: MI
PostalCode: 48313
CountryCode: US
TelephoneNumber: 5869771510
FaxNumber: 5869773261
Other Information
ProviderEnumerationDate: 08/14/2007
LastUpdateDate: 08/04/2010
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: FOGARTY
AuthorizedOfficialFirstName: TOM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SENIOR VP/ CHIEF MEDICAL OFFICER
AuthorizedOfficialTelephone: 9723648103
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X  N Ambulatory Health Care FacilitiesClinic/Center 
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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