Provider Demographics
NPI:1225103047
Name:NORTH MACOMB MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NORTH MACOMB MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FROCILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-727-5840
Mailing Address - Street 1:66707 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48050-2019
Mailing Address - Country:US
Mailing Address - Phone:586-727-5840
Mailing Address - Fax:586-727-5897
Practice Address - Street 1:66707 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48050-2019
Practice Address - Country:US
Practice Address - Phone:586-727-5840
Practice Address - Fax:586-727-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N74950Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER