Provider Demographics
NPI:1336175041
Name:PRIMARY CARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONTPETIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-445-2330
Mailing Address - Street 1:18263 E 10 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5805
Mailing Address - Country:US
Mailing Address - Phone:586-445-2330
Mailing Address - Fax:586-445-2352
Practice Address - Street 1:18263 E 10 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-445-2330
Practice Address - Fax:586-445-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGM048923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3232662Medicaid
MIDM038055OtherSTATE LICENSE
MI1105016431OtherBCBSM
MIGM048923OtherSTATE LICENSE
MI2708570Medicaid
110042849OtherRAILROAD MEDICARE
MI1105017110OtherBCBSM
110131072OtherRAILROAD MEDICARE
110131072OtherRAILROAD MEDICARE
MIP21650002Medicare PIN
MI1105016431OtherBCBSM
MIP21650001Medicare PIN