Provider Demographics
NPI:1669521746
Name:PREFERRED FAMILY MEDICINE PC
Entity type:Organization
Organization Name:PREFERRED FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:248-543-0600
Mailing Address - Street 1:1200 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4439
Mailing Address - Country:US
Mailing Address - Phone:248-543-0600
Mailing Address - Fax:248-543-0562
Practice Address - Street 1:1200 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4439
Practice Address - Country:US
Practice Address - Phone:248-543-0600
Practice Address - Fax:248-543-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMW008700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG79744Medicare UPIN
MIG78773Medicare UPIN
MIE49499Medicare UPIN
MIG16664Medicare UPIN