Provider Demographics
NPI:1508201013
Name:ADVANCED MEDICAL HOUSE CALLS, PLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL HOUSE CALLS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-853-5875
Mailing Address - Street 1:14165 N. FENTON ROAD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1128
Mailing Address - Country:US
Mailing Address - Phone:810-853-5875
Mailing Address - Fax:586-279-4515
Practice Address - Street 1:14165 N FENTON RD STE 201A
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1584
Practice Address - Country:US
Practice Address - Phone:810-853-5875
Practice Address - Fax:586-279-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6835Medicare PIN