Provider Demographics
NPI:1710250147
Name:MY HOME DOCTORS PLLC
Entity Type:Organization
Organization Name:MY HOME DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-293-1868
Mailing Address - Street 1:30140 HARPER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1610
Mailing Address - Country:US
Mailing Address - Phone:586-359-6983
Mailing Address - Fax:586-293-1869
Practice Address - Street 1:30140 HARPER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1610
Practice Address - Country:US
Practice Address - Phone:586-359-6983
Practice Address - Fax:586-293-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088798302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization