Provider Demographics
NPI:1013541614
Name:PRIMECARE FAMILY MEDICINE CONCIERGE CENTER PLLC
Entity Type:Organization
Organization Name:PRIMECARE FAMILY MEDICINE CONCIERGE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-246-0505
Mailing Address - Street 1:25029 SKYE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1669
Mailing Address - Country:US
Mailing Address - Phone:248-246-0505
Mailing Address - Fax:
Practice Address - Street 1:33466 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5208
Practice Address - Country:US
Practice Address - Phone:248-246-0505
Practice Address - Fax:248-284-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty