Provider Demographics
NPI:1013043306
Name:OPDYKE FAMILY MEDICAL, P.C.
Entity Type:Organization
Organization Name:OPDYKE FAMILY MEDICAL, P.C.
Other - Org Name:SPRINGFIELD FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-333-2600
Mailing Address - Street 1:719 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3436
Mailing Address - Country:US
Mailing Address - Phone:248-333-2600
Mailing Address - Fax:248-333-3250
Practice Address - Street 1:719 S OPDYKE RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3436
Practice Address - Country:US
Practice Address - Phone:248-333-2600
Practice Address - Fax:248-333-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK010353207Q00000X
MIPH010351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2802198Medicaid
MI2802189Medicaid
MI2802198Medicaid
MIE49715Medicare UPIN
MI2802189Medicaid
MIF37107001Medicare ID - Type UnspecifiedKULICK MR