Provider Demographics
NPI:1740035955
Name:PHYSICIAN PRIMARY CARE PLLC
Entity type:Organization
Organization Name:PHYSICIAN PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-500-9250
Mailing Address - Street 1:1131 SILVER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4284
Mailing Address - Country:US
Mailing Address - Phone:586-500-9250
Mailing Address - Fax:586-500-9251
Practice Address - Street 1:35700 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3808
Practice Address - Country:US
Practice Address - Phone:586-500-9250
Practice Address - Fax:586-500-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty