Provider Demographics
NPI:1023047883
Name:MY HOME DOCTOR,P.C.
Entity type:Organization
Organization Name:MY HOME DOCTOR,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ATAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-887-0477
Mailing Address - Street 1:317 ECORSE RD
Mailing Address - Street 2:SUITE # 14
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5787
Mailing Address - Country:US
Mailing Address - Phone:866-887-0477
Mailing Address - Fax:734-448-0130
Practice Address - Street 1:317 ECORSE RD
Practice Address - Street 2:SUITE # 14
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5787
Practice Address - Country:US
Practice Address - Phone:866-887-0477
Practice Address - Fax:734-448-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P19150Medicare ID - Type UnspecifiedVISITING PHYSICIANS OFF.