Provider Demographics
NPI:1083074850
Name:ADVANCE PROFESSIONAL PATIENT CARE PLLC
Entity Type:Organization
Organization Name:ADVANCE PROFESSIONAL PATIENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEIUTTENUN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-894-1500
Mailing Address - Street 1:901 W GRAND BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2353
Mailing Address - Country:US
Mailing Address - Phone:313-894-1500
Mailing Address - Fax:313-894-1501
Practice Address - Street 1:901 W GRAND BLVD
Practice Address - Street 2:STE 101
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2353
Practice Address - Country:US
Practice Address - Phone:313-894-1500
Practice Address - Fax:313-894-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088766261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN