Provider Demographics
NPI:1356522247
Name:PRIMARY CARE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:PRIMARY CARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-641-8900
Mailing Address - Street 1:33611 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2787
Mailing Address - Country:US
Mailing Address - Phone:734-641-8900
Mailing Address - Fax:734-641-8970
Practice Address - Street 1:33611 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2787
Practice Address - Country:US
Practice Address - Phone:734-641-8900
Practice Address - Fax:734-641-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4383661Medicaid
MI4383670Medicaid
G16535Medicare UPIN
MIF03778Medicare UPIN