Provider Demographics
NPI:1356093462
Name:AMC PRIMARY CARE & CONSULTANTS PLLC
Entity type:Organization
Organization Name:AMC PRIMARY CARE & CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-578-1911
Mailing Address - Street 1:23850 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2325
Mailing Address - Country:US
Mailing Address - Phone:313-578-1911
Mailing Address - Fax:
Practice Address - Street 1:23850 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2325
Practice Address - Country:US
Practice Address - Phone:313-578-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid