Provider Demographics
NPI:1013969047
Name:PRIME CARE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANAA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-5882
Mailing Address - Street 1:22150 GREENFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2535
Mailing Address - Country:US
Mailing Address - Phone:248-967-5882
Mailing Address - Fax:
Practice Address - Street 1:22150 GREENFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2535
Practice Address - Country:US
Practice Address - Phone:248-967-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82630Medicare ID - Type Unspecified