Provider Demographics
NPI:1558759183
Name:PRIMARY CARE MEDICINE, PC
Entity Type:Organization
Organization Name:PRIMARY CARE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-266-0206
Mailing Address - Street 1:8359 OFFICE PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2078
Mailing Address - Country:US
Mailing Address - Phone:810-266-0206
Mailing Address - Fax:
Practice Address - Street 1:14272 N FENTON RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1544
Practice Address - Country:US
Practice Address - Phone:810-714-5100
Practice Address - Fax:810-714-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty