Provider Demographics
NPI:1568530053
Name:PRIMARY CARE CENTER
Entity Type:Organization
Organization Name:PRIMARY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEERAN
Authorized Official - Middle Name:YOUSIF
Authorized Official - Last Name:BAJOUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-443-7140
Mailing Address - Street 1:18161 W 12 MILE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2662
Mailing Address - Country:US
Mailing Address - Phone:248-443-7140
Mailing Address - Fax:248-443-7141
Practice Address - Street 1:18161 W 12 MILE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2662
Practice Address - Country:US
Practice Address - Phone:248-443-7140
Practice Address - Fax:248-443-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82350Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER