Provider Demographics
NPI:1942309091
Name:PLUMBROOK MEDICAL CENTER PC
Entity Type:Organization
Organization Name:PLUMBROOK MEDICAL CENTER PC
Other - Org Name:DR LEROY S NEUMANN AND DR FREDRIC I NEUMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:I
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-939-9060
Mailing Address - Street 1:39880 VAN DYKE
Mailing Address - Street 2:STE 102
Mailing Address - City:STERLING HGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313
Mailing Address - Country:US
Mailing Address - Phone:586-939-9060
Mailing Address - Fax:586-939-6639
Practice Address - Street 1:39880 VAN DYKE
Practice Address - Street 2:STE 102
Practice Address - City:STERLING HGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-939-9060
Practice Address - Fax:586-939-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFN009587207Q00000X
MILN004676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E01042OtherBCBS
MI3229756Medicaid
MI23D0371615OtherCLIA
MI080082386OtherRAILROAD MEDICARE
MI3229747Medicaid
MI43253579OtherAETNA
MI3229747Medicaid
MI43253579OtherAETNA
MI3229756Medicaid
MI080082386OtherRAILROAD MEDICARE