Provider Demographics
NPI:1033345889
Name:COMPREHENSIVE HEALTH CARE CENTER OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTH CARE CENTER OF MICHIGAN, PLLC
Other - Org Name:ROCHESTER LIFESTYLE CHANGE & HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:KPADENOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:586-731-7250
Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-731-8200
Mailing Address - Fax:586-731-8922
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-731-8200
Practice Address - Fax:586-731-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI33869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2716948Medicaid
MI2716948Medicaid
6630016Medicare PIN