Provider Demographics
NPI:1083762793
Name:NEW HORIZONS MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:NEW HORIZONS MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-474-4900
Mailing Address - Street 1:19335 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1754
Mailing Address - Country:US
Mailing Address - Phone:248-474-4900
Mailing Address - Fax:
Practice Address - Street 1:19335 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1754
Practice Address - Country:US
Practice Address - Phone:248-474-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H24860OtherBLUE CROSS BLUE SHIELD
MI080H24860OtherBLUE CROSS BLUE SHIELD
MI0N52520Medicare ID - Type UnspecifiedMEDICARE