Provider Demographics
NPI:1972974806
Name:ADVANCED HOUSE CALLS, LLC
Entity Type:Organization
Organization Name:ADVANCED HOUSE CALLS, LLC
Other - Org Name:ADVANCED MANAGEMENT HOUSE CALLS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:810-853-5875
Mailing Address - Street 1:3771 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-1831
Mailing Address - Country:US
Mailing Address - Phone:810-853-5875
Mailing Address - Fax:586-279-4515
Practice Address - Street 1:3771 HIGHLAND CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48356-1831
Practice Address - Country:US
Practice Address - Phone:810-853-5875
Practice Address - Fax:586-279-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208764207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty