Provider Demographics
NPI:1467759928
Name:PERSONALIZED MEDICAL CARE ASSOC P C
Entity Type:Organization
Organization Name:PERSONALIZED MEDICAL CARE ASSOC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-946-4905
Mailing Address - Street 1:21580 NOVI RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5600
Mailing Address - Country:US
Mailing Address - Phone:248-946-4905
Mailing Address - Fax:888-502-9335
Practice Address - Street 1:21580 NOVI RD
Practice Address - Street 2:STE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5600
Practice Address - Country:US
Practice Address - Phone:248-946-4905
Practice Address - Fax:888-502-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090829261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center