| Family Medicine Pc | |
|
29255 Northwestern Hwy Suite 203 Southfield MI 48034-1018 | |
| (248) 557-0535 | |
| (248) 557-6145 |
| Full Name | Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 29255 Northwestern Hwy, Southfield, Michigan |
| Authorized Official Name and Position | Rodrigo Tobar (SECRETARY/TREASURER) |
| Authorized Official Contact | 2485570535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Pc 29255 Northwestern Hwy Suite 203 Southfield MI 48034-1018 Ph: (248) 557-0535 | Family Medicine Pc 29255 Northwestern Hwy Suite 203 Southfield MI 48034-1018 Ph: (248) 557-0535 |
| NPI Number | 1417921628 |
|---|---|
| Provider Enumeration Date | 02/14/2006 |
| Last Update Date | 01/18/2012 |
| Medicare PECOS PAC ID | 0840316550 |
|---|---|
| Medicare Enrollment ID | O20100929001577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417921628 | NPI | - | NPPES |
| 5630421 | Other | MI | PIN NUMBER |
| 008750 | Other | MI | DETROIT MEDICAL CENTER |
| 0638787 | Other | MI | PIN NUMBER |
| 080165831 | Other | MI | PALMETTO GBA |
| 2691080 | Medicaid | MI | |
| 080F364760 | Other | MI | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | RT008998 (Michigan) | Primary |
| Provider Name | Rodrigo Tobar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316014566 PECOS PAC ID: 5395861009 Enrollment ID: I20101201000375 |
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