Basic Information
Provider Information
NPI: 1588199772
EntityType: 2
ReplacementNPI:  
OrganizationName: FAMILY MEDICINE CONSULTANTS PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 30700 TELEGRAPH RD
Address2: SUITE 1645
City: BINGHAM FARMS
State: MI
PostalCode: 480254524
CountryCode: US
TelephoneNumber: 2482831100
FaxNumber: 2482831103
Practice Location
Address1: 24336 MICHIGAN AVE
Address2:  
City: DEARBORN
State: MI
PostalCode: 481241828
CountryCode: US
TelephoneNumber: 2482831100
FaxNumber: 2482831103
Other Information
ProviderEnumerationDate: 04/25/2017
LastUpdateDate: 04/25/2017
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HAQ
AuthorizedOfficialFirstName: JUNAED
AuthorizedOfficialMiddleName: UL
AuthorizedOfficialTitleorPosition: PARTNER
AuthorizedOfficialTelephone: 2482831100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

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

No ID Information.


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