Provider Demographics
NPI:1639689854
Name:MACOMB PRIMARY CARE, P.C
Entity Type:Organization
Organization Name:MACOMB PRIMARY CARE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHADI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-323-0301
Mailing Address - Street 1:11051 HALL ROAD
Mailing Address - Street 2:SUTIE 120
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317
Mailing Address - Country:US
Mailing Address - Phone:586-323-0301
Mailing Address - Fax:286-323-0341
Practice Address - Street 1:851 SOUTH MAIN STREET
Practice Address - Street 2:SUITE #3
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-354-0020
Practice Address - Fax:586-323-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies