Provider Demographics
NPI:1558761866
Name:NEW FAITH MEDICAL CENTER
Entity Type:Organization
Organization Name:NEW FAITH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMITKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-539-4840
Mailing Address - Street 1:28200 7 MILE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3794
Mailing Address - Country:US
Mailing Address - Phone:313-539-4840
Mailing Address - Fax:
Practice Address - Street 1:28200 7 MILE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3794
Practice Address - Country:US
Practice Address - Phone:313-539-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092021104100000X
MI1041C0700X
MI4301043030207R00000X
MI5601002272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty