Provider Demographics
NPI:1598202467
Name:MERCY FAMILY CARE CENTER PLLC
Entity Type:Organization
Organization Name:MERCY FAMILY CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-854-4206
Mailing Address - Street 1:4091 CHATWAL CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-0001
Mailing Address - Country:US
Mailing Address - Phone:248-854-4206
Mailing Address - Fax:
Practice Address - Street 1:4091 CHATWAL CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-0001
Practice Address - Country:US
Practice Address - Phone:248-854-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094540207Q00000X
MI4301092314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty