Provider Demographics
NPI:1720290620
Name:DMC PRIMARY CARE SERVICES II
Entity Type:Organization
Organization Name:DMC PRIMARY CARE SERVICES II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-603-4096
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPT 100201
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:248-603-4240
Mailing Address - Fax:248-603-4249
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:#400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-4200
Practice Address - Fax:313-966-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N62850Medicare PIN
MI0N37790Medicare PIN
MI0N36870Medicare PIN