Provider Demographics
NPI:1518059914
Name:PRIME HEALTH CARE PC
Entity Type:Organization
Organization Name:PRIME HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUTAHHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-840-7480
Mailing Address - Street 1:27620 FARMINGTON RD
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3349
Mailing Address - Country:US
Mailing Address - Phone:248-840-7480
Mailing Address - Fax:800-660-6187
Practice Address - Street 1:27620 FARMINGTON RD
Practice Address - Street 2:SUITE B-10
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3349
Practice Address - Country:US
Practice Address - Phone:248-840-7480
Practice Address - Fax:800-660-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065663261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4756764Medicaid
MIG84021Medicare UPIN
MI4756764Medicaid