Provider Demographics
NPI:1093842510
Name:BLUE CARE NETWORK OF MI
Entity Type:Organization
Organization Name:BLUE CARE NETWORK OF MI
Other - Org Name:FAMILY HEALTH CENTER OF BLUE CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP AND CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KESHISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-799-6843
Mailing Address - Street 1:1401 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8507
Mailing Address - Country:US
Mailing Address - Phone:517-322-4000
Mailing Address - Fax:517-322-4009
Practice Address - Street 1:1401 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8507
Practice Address - Country:US
Practice Address - Phone:517-322-4000
Practice Address - Fax:517-322-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty