Provider Demographics
NPI:1821326695
Name:MIDWEST MEDICAL POINT OF CARE PC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL POINT OF CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANAQUIL
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-0749
Mailing Address - Street 1:16000 W 9 MILE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4808
Mailing Address - Country:US
Mailing Address - Phone:248-569-0749
Mailing Address - Fax:
Practice Address - Street 1:16000 W 9 MILE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4808
Practice Address - Country:US
Practice Address - Phone:248-569-0749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty