Provider Demographics
NPI:1578610580
Name:ALLENWOOD FAMILY HEALTH CARE, PC
Entity Type:Organization
Organization Name:ALLENWOOD FAMILY HEALTH CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFINI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-403-2222
Mailing Address - Street 1:11368 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4372
Mailing Address - Country:US
Mailing Address - Phone:734-403-2222
Mailing Address - Fax:734-403-2400
Practice Address - Street 1:11368 ALLEN RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4372
Practice Address - Country:US
Practice Address - Phone:734-403-2222
Practice Address - Fax:734-403-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517442-11Medicaid
MI4517451-11Medicaid
MI4517442-11Medicaid
MIG14844Medicare UPIN
MI4517451-11Medicaid
MION77330Medicare ID - Type UnspecifiedPRACTICE MEDICARE ID
MI4517442-11Medicaid