Basic Information
| Provider Information | |||||||||
| NPI: | 1811039845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE OF HOME CARE PHYSICIANS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28001 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867727180 | ||||||||
| FaxNumber: | 5862790033 | ||||||||
| Practice Location | |||||||||
| Address1: | 2104 E 11 MILE RD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480916122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867586222 | ||||||||
| FaxNumber: | 5867586232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARNETT | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5867727180 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | E83365 | 01 | MI | HAP SENIOR PLUS | OTHER | 4892176 | 05 | MI | MEDICAID |