Provider Demographics
NPI:1083858328
Name:CENTERLINE FAMILY PRACTICE CENTER PC
Entity Type:Organization
Organization Name:CENTERLINE FAMILY PRACTICE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-754-3830
Mailing Address - Street 1:8033 E 10 MILE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1454
Mailing Address - Country:US
Mailing Address - Phone:856-755-6101
Mailing Address - Fax:
Practice Address - Street 1:8033 E 10 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1454
Practice Address - Country:US
Practice Address - Phone:586-755-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty