Provider Demographics
NPI:1649594367
Name:BI COUNTY MEDICAL PRACTICES
Entity Type:Organization
Organization Name:BI COUNTY MEDICAL PRACTICES
Other - Org Name:HENRY FORD MACOMB HOSPITAL WARREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODBALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-263-2705
Mailing Address - Street 1:PO BOX 673195
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3195
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:28001 SCHOENHERR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4396
Practice Address - Country:US
Practice Address - Phone:586-558-9966
Practice Address - Fax:586-558-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E000820OtherBCBSM/BCN
MI0N65730Medicare PIN