Provider Demographics
NPI:1568636983
Name:ANN ARBOR FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:ANN ARBOR FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:EDELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-747-8500
Mailing Address - Street 1:955 W EISENHOWER CIR
Mailing Address - Street 2:STE D
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5868
Mailing Address - Country:US
Mailing Address - Phone:734-747-8500
Mailing Address - Fax:734-747-8547
Practice Address - Street 1:955 W EISENHOWER CIR
Practice Address - Street 2:STE D
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5868
Practice Address - Country:US
Practice Address - Phone:734-747-8500
Practice Address - Fax:734-747-8547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKE406952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0808108511OtherBCBS MICHIGAN
MI435227010Medicaid
MI435227010Medicaid