Provider Demographics
NPI:1508614447
Name:FACILICARE CLINICAL MICHIGAN PLLC
Entity Type:Organization
Organization Name:FACILICARE CLINICAL MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JYLNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-845-4237
Mailing Address - Street 1:PO BOX 2137
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 E BROWN ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6201
Practice Address - Country:US
Practice Address - Phone:248-845-4237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center