Provider Demographics
NPI:1851711642
Name:MAIN STREET MEDICAL & COUNSELING CENTER PLC
Entity Type:Organization
Organization Name:MAIN STREET MEDICAL & COUNSELING CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-972-9184
Mailing Address - Street 1:103 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8095
Mailing Address - Country:US
Mailing Address - Phone:734-474-1525
Mailing Address - Fax:734-878-5103
Practice Address - Street 1:103 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169
Practice Address - Country:US
Practice Address - Phone:734-474-1525
Practice Address - Fax:734-878-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083561261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care