Provider Demographics
NPI:1316362999
Name:DEARBORN PRIMARY CARE, P.C.
Entity Type:Organization
Organization Name:DEARBORN PRIMARY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANAJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-9128
Mailing Address - Street 1:22260 GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2208
Mailing Address - Country:US
Mailing Address - Phone:313-562-9128
Mailing Address - Fax:313-562-1020
Practice Address - Street 1:22260 GARRISON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2208
Practice Address - Country:US
Practice Address - Phone:313-562-9128
Practice Address - Fax:313-562-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301060584OtherLICENSE