Provider Demographics
NPI:1073764932
Name:WADHAMS FAMILY CARE PLLC
Entity Type:Organization
Organization Name:WADHAMS FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-984-2693
Mailing Address - Street 1:5312 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1424
Mailing Address - Country:US
Mailing Address - Phone:810-984-2693
Mailing Address - Fax:810-984-2669
Practice Address - Street 1:5312 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1424
Practice Address - Country:US
Practice Address - Phone:810-984-2693
Practice Address - Fax:810-984-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGJ012784261QP2300X
MIPS012787261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherCOMMERCIAL
MIG74989Medicare UPIN
MIG74990Medicare UPIN