Provider Demographics
NPI:1760781009
Name:DOWNRIVER FAMILY CARE LLC
Entity Type:Organization
Organization Name:DOWNRIVER FAMILY CARE LLC
Other - Org Name:DOWNRIVER FAMILY CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SADIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-250-1285
Mailing Address - Street 1:26375 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4352
Mailing Address - Country:US
Mailing Address - Phone:734-250-1285
Mailing Address - Fax:313-945-5455
Practice Address - Street 1:26375 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-4352
Practice Address - Country:US
Practice Address - Phone:734-250-1285
Practice Address - Fax:313-945-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty