Provider Demographics
NPI:1740451780
Name:FAMILY HEALTH AND MEDICINE PC
Entity type:Organization
Organization Name:FAMILY HEALTH AND MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-960-9140
Mailing Address - Street 1:39525 W 14 MILE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1632
Mailing Address - Country:US
Mailing Address - Phone:248-960-9140
Mailing Address - Fax:248-960-9145
Practice Address - Street 1:39525 W 14 MILE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1632
Practice Address - Country:US
Practice Address - Phone:248-960-9140
Practice Address - Fax:248-960-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI5101012499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG70766Medicare UPIN
MI0N98890001Medicare PIN