Basic Information
| Provider Information | |||||||||
| NPI: | 1720171622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAREMED, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 LINDEN CREEK PARKWAY | ||||||||
| Address2: | SUITE D | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107203775 | ||||||||
| FaxNumber: | 8107203835 | ||||||||
| Practice Location | |||||||||
| Address1: | 7277 BERNICE | ||||||||
| Address2: | SUITE #102 | ||||||||
| City: | CENTERLINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867552496 | ||||||||
| FaxNumber: | 5864979364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOM | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | GERARD | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 8107330280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336M0002X | Y | Suppliers | Pharmacy | Mail Order Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4717686 | 05 | MI | MEDICAID |