Basic Information
| Provider Information | |||||||||
| NPI: | 1518349935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MACOMB COUNTY COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22550 HALL RD | ||||||||
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| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480361189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864695275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6555 15 MILE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483124511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869480224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | JOSEF | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5864675774 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6801097975 | MI | Y | Agencies | Community/Behavioral Health |
No ID Information.