Provider Demographics
NPI:1265629315
Name:COMPREHENSIVE FAMILY MEDICAL
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-937-1190
Mailing Address - Street 1:27144 JOY RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2368
Mailing Address - Country:US
Mailing Address - Phone:313-937-1190
Mailing Address - Fax:313-937-1077
Practice Address - Street 1:27144 JOY RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2368
Practice Address - Country:US
Practice Address - Phone:313-937-1190
Practice Address - Fax:313-937-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPP007761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24770Medicare PIN