Provider Demographics
NPI:1265773022
Name:PRIMARY MEDICAL SERVICES PC
Entity type:Organization
Organization Name:PRIMARY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRYCJA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CZESNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-925-7702
Mailing Address - Street 1:74321 JUDGES CT
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-3125
Mailing Address - Country:US
Mailing Address - Phone:586-925-7702
Mailing Address - Fax:248-721-8089
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:STE 108
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-336-2008
Practice Address - Fax:248-721-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty