| Mundy Family Care Pllc | |
|
2469 W Hill Rd Flint MI 48507-3883 | |
| (810) 407-6039 | |
| Not Available |
| Full Name | Mundy Family Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2469 W Hill Rd, Flint, Michigan |
| Authorized Official Name and Position | Wade Dilley (OFFICE MANAGER) |
| Authorized Official Contact | 8104076039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mundy Family Care Pllc 2469 W Hill Rd Flint MI 48507-3883 Ph: (810) 407-6039 | Mundy Family Care Pllc 2469 W Hill Rd Flint MI 48507-3883 Ph: (810) 407-6039 |
| NPI Number | 1285139535 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 03/30/2018 |
| Medicare PECOS PAC ID | 0244588226 |
|---|---|
| Medicare Enrollment ID | O20180808000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285139535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ralph Scott Lazzara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710978689 PECOS PAC ID: 4486546595 Enrollment ID: I20041223000185 |
| Provider Name | Toni Detwiler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861910416 PECOS PAC ID: 4688001415 Enrollment ID: I20200217003399 |
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