| Primecare Of Novi Pllc | |
|
39555 West Ten Mile Rd Suite 302 Novi MI 48375-2950 | |
| (248) 426-7200 | |
| (248) 426-7335 |
| Full Name | Primecare Of Novi Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 39555 West Ten Mile Rd, Novi, Michigan |
| Authorized Official Name and Position | Theodore W Shively (MEMBER) |
| Authorized Official Contact | 2484267200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Of Novi Pllc 39555 West Ten Mile Rd Suite 302 Novi MI 48375-2950 Ph: (248) 426-7200 | Primecare Of Novi Pllc 39555 West Ten Mile Rd Suite 302 Novi MI 48375-2950 Ph: (248) 426-7200 |
| NPI Number | 1235281916 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 01/25/2010 |
| Medicare PECOS PAC ID | 2264326883 |
|---|---|
| Medicare Enrollment ID | O20040212000644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235281916 | NPI | - | NPPES |
| 0F316970 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Theodore W Shively |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780666461 PECOS PAC ID: 2769376383 Enrollment ID: I20040217000153 |
| Provider Name | Robert R Zaid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679647200 PECOS PAC ID: 5193891521 Enrollment ID: I20080908000532 |
| Provider Name | Hannah R Boike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639601677 PECOS PAC ID: 5496010043 Enrollment ID: I20180531001432 |
| Provider Name | Marybeth M Kostiuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932640398 PECOS PAC ID: 6709156862 Enrollment ID: I20181015001954 |
| Provider Name | Lauren M Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265915748 PECOS PAC ID: 4082948476 Enrollment ID: I20190618002193 |
| Provider Name | Bandi R Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356866842 PECOS PAC ID: 5991031742 Enrollment ID: I20190731002763 |
| Provider Name | Alexander Geno Zayid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699331496 PECOS PAC ID: 2466787684 Enrollment ID: I20220624000769 |
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