Provider Demographics
NPI:1760462253
Name:COUNTY OF MACOMB
Entity Type:Organization
Organization Name:COUNTY OF MACOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOKAR
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:586-469-5512
Mailing Address - Street 1:43525 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-1034
Mailing Address - Country:US
Mailing Address - Phone:586-469-5235
Mailing Address - Fax:586-469-5885
Practice Address - Street 1:43525 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1034
Practice Address - Country:US
Practice Address - Phone:586-469-5235
Practice Address - Fax:586-469-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052675251K00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09300Medicare PIN