Basic Information
Provider Information
NPI: 1578795852
EntityType: 2
ReplacementNPI:  
OrganizationName: AMERICAN CURRENT CARE OF MICHIGAN, P.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5080 SPECTRUM DR
Address2: SUITE 1200 WEST
City: ADDISON
State: TX
PostalCode: 750014648
CountryCode: US
TelephoneNumber: 9723648000
FaxNumber:  
Practice Location
Address1: 1915 N PERRY ST
Address2:  
City: PONTIAC
State: MI
PostalCode: 483402237
CountryCode: US
TelephoneNumber: 2482763999
FaxNumber: 2482763998
Other Information
ProviderEnumerationDate: 08/20/2009
LastUpdateDate: 08/20/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FOGARTY
AuthorizedOfficialFirstName: W
AuthorizedOfficialMiddleName: TOM
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9723648000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

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

No ID Information.


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