Provider Demographics
NPI:1649355892
Name:MACOMB COUNTY VILLAGE CLINIC PC
Entity type:Organization
Organization Name:MACOMB COUNTY VILLAGE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ONGENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-727-2761
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:31505 32 MILE RD
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062
Mailing Address - Country:US
Mailing Address - Phone:586-727-2761
Mailing Address - Fax:586-722-3120
Practice Address - Street 1:31505 32 MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062
Practice Address - Country:US
Practice Address - Phone:586-727-2761
Practice Address - Fax:586-727-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty