Provider Demographics
NPI:1376718833
Name:MONROE AFTER HOURS PRIMARY CARE PC
Entity Type:Organization
Organization Name:MONROE AFTER HOURS PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYMM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETSZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-243-3420
Mailing Address - Street 1:1397 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5360
Mailing Address - Country:US
Mailing Address - Phone:734-243-3420
Mailing Address - Fax:
Practice Address - Street 1:1397 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5360
Practice Address - Country:US
Practice Address - Phone:734-243-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty