Provider Demographics
NPI:1437120185
Name:CRITICAL CARE MEDICINE PARTNERS, PC
Entity Type:Organization
Organization Name:CRITICAL CARE MEDICINE PARTNERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-467-4150
Mailing Address - Street 1:DEPT 259301
Mailing Address - Street 2:P O BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2593
Mailing Address - Country:US
Mailing Address - Phone:734-467-4150
Mailing Address - Fax:313-791-2432
Practice Address - Street 1:116 S DENWOOD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:734-467-4150
Practice Address - Fax:313-791-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084496207LC0200X
MI5101020852207P00000X
MI4301093939207R00000X
MI4301054803207RC0200X
207RN0300X, 2086S0102X
MI4301094495207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437120185Medicaid
MI0N50720Medicare PIN