| Baco Care Services Llc | |
|
26901 Beaumont Blvd Southfield MI 48033-3849 | |
| (947) 522-0031 | |
| Not Available |
| Full Name | Baco Care Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 26901 Beaumont Blvd, Southfield, Michigan |
| Authorized Official Name and Position | Walter Lorang (CEO) |
| Authorized Official Contact | 9475220037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baco Care Services Llc 26901 Beaumont Blvd Southfield MI 48033-3849 Ph: (947) 522-0031 | Baco Care Services Llc 26901 Beaumont Blvd Southfield MI 48033-3849 Ph: (947) 522-0031 |
| NPI Number | 1780294850 |
|---|---|
| Provider Enumeration Date | 08/04/2020 |
| Last Update Date | 10/23/2022 |
| Medicare PECOS PAC ID | 6103286737 |
|---|---|
| Medicare Enrollment ID | O20230714000925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780294850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ghadi Gabriel Ghorayeb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932158425 PECOS PAC ID: 0244208882 Enrollment ID: I20040921000789 |
| Provider Name | Stephen A Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962464982 PECOS PAC ID: 6608909932 Enrollment ID: I20100806000086 |
| Provider Name | Marcelli Jade Gayonoche Contreras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033496955 PECOS PAC ID: 1052606969 Enrollment ID: I20160817000049 |
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