Provider Demographics
NPI:1346690245
Name:GOLDEN FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:GOLDEN FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BASKET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-945-0482
Mailing Address - Street 1:23463 E SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3155
Mailing Address - Country:US
Mailing Address - Phone:734-945-0482
Mailing Address - Fax:
Practice Address - Street 1:23463 E SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3155
Practice Address - Country:US
Practice Address - Phone:734-945-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510108586261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437478070Medicaid