Provider Demographics
NPI:1205071685
Name:FAITHFUL, CARING& COMPASSIONATE DOCTORS, PLC
Entity type:Organization
Organization Name:FAITHFUL, CARING& COMPASSIONATE DOCTORS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-354-0767
Mailing Address - Street 1:19111 W 10 MILE RD
Mailing Address - Street 2:SUITE # 164
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2449
Mailing Address - Country:US
Mailing Address - Phone:248-354-0767
Mailing Address - Fax:248-354-0806
Practice Address - Street 1:19111 W 10 MILE RD
Practice Address - Street 2:SUITE # 164
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2417
Practice Address - Country:US
Practice Address - Phone:248-354-0767
Practice Address - Fax:248-354-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106335072OtherBCBS PIN
MI3511909Medicaid
MIG76079Medicare UPIN
MI3511909Medicaid