Provider Demographics
NPI:1669682951
Name:HOUSECALL PHYSICIANS OF SOUTHWEST MICHIGAN PLC
Entity Type:Organization
Organization Name:HOUSECALL PHYSICIANS OF SOUTHWEST MICHIGAN PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-327-3700
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-1147
Mailing Address - Country:US
Mailing Address - Phone:269-327-3700
Mailing Address - Fax:269-323-0229
Practice Address - Street 1:5084 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1557
Practice Address - Country:US
Practice Address - Phone:269-327-3700
Practice Address - Fax:269-323-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068834208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI340020811OtherMEDICARE RAIL ROAD
MI4421824Medicaid
MI340020811OtherMEDICARE RAIL ROAD
MI0N53870Medicare ID - Type Unspecified