| Berkley Primary Care, Plc | |
|
26711 Woodward Ave Ste 103 Huntington Woods MI 48070-1367 | |
| (248) 543-6000 | |
| (248) 543-3770 |
| Full Name | Berkley Primary Care, Plc |
|---|---|
| Speciality | Internal Medicine |
| Location | 26711 Woodward Ave Ste 103, Huntington Woods, Michigan |
| Authorized Official Name and Position | Terry S Vacheresse (OFFICE MANAGER) |
| Authorized Official Contact | 2485436000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Berkley Primary Care, Plc 26711 Woodward Ave Ste 103 Huntington Woods MI 48070-1367 Ph: (248) 543-6000 | Berkley Primary Care, Plc 26711 Woodward Ave Ste 103 Huntington Woods MI 48070-1367 Ph: (248) 543-6000 |
| NPI Number | 1316082399 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 02/03/2015 |
| Medicare PECOS PAC ID | 8325052251 |
|---|---|
| Medicare Enrollment ID | O20060131000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316082399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (Michigan) | Secondary |
| Provider Name | Lisa A Fulgenzi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962475236 PECOS PAC ID: 4587678412 Enrollment ID: I20120313000175 |
Primary Medical Services Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 26711 Woodward Ave, Ste 108, Huntington Woods, MI 48070 Phone: 248-336-2008 Fax: 248-721-8089 |