Provider Demographics
NPI:1003342908
Name:MOBILE MEDICAL CARE PLLC
Entity type:Organization
Organization Name:MOBILE MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENZILE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSONMENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-752-4353
Mailing Address - Street 1:22601 ALLEN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2273
Mailing Address - Country:US
Mailing Address - Phone:734-752-4353
Mailing Address - Fax:
Practice Address - Street 1:22601 ALLEN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2273
Practice Address - Country:US
Practice Address - Phone:734-752-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016237207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598891863OtherINDIVIDUAL NPI
MI40919OtherAMERICAN BOARD OF EMERGENCY MEDICINE
MI5101016237OtherMI LICENSE