Provider Demographics
NPI:1740398940
Name:AVCI MEDICAL CENTER
Entity Type:Organization
Organization Name:AVCI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUNSEL
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:AVCI-WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-363-7109
Mailing Address - Street 1:1990 UNION LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2202
Mailing Address - Country:US
Mailing Address - Phone:248-363-7109
Mailing Address - Fax:
Practice Address - Street 1:1990 UNION LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2202
Practice Address - Country:US
Practice Address - Phone:248-363-7109
Practice Address - Fax:248-363-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGA012197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3154038Medicaid
MI3154038Medicaid
F70562Medicare UPIN