Provider Demographics
NPI:1457526428
Name:FARMBROOKE FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:FARMBROOKE FAMILY PHYSICIANS PC
Other - Org Name:FARMBROOKE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIKORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-566-1310
Mailing Address - Street 1:48924 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1955
Mailing Address - Country:US
Mailing Address - Phone:586-566-1310
Mailing Address - Fax:586-566-8404
Practice Address - Street 1:48924 HAYES RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1955
Practice Address - Country:US
Practice Address - Phone:586-566-1310
Practice Address - Fax:586-566-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5500103Medicare PIN