Provider Demographics
NPI:1487814158
Name:PRECHEL FAMILY CLINIC, PC
Entity Type:Organization
Organization Name:PRECHEL FAMILY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIM
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRECHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-584-3624
Mailing Address - Street 1:16551 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3706
Mailing Address - Country:US
Mailing Address - Phone:313-584-3624
Mailing Address - Fax:313-584-8060
Practice Address - Street 1:16551 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3706
Practice Address - Country:US
Practice Address - Phone:313-584-3624
Practice Address - Fax:313-584-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWP5101006899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1294700Medicaid
MIE26901OtherUPIN
MI0858210715OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI5820569Medicare UPIN
MI1294700Medicaid