Provider Demographics
NPI:1740623222
Name:AMERICAN HOME DOCTORS PC
Entity type:Organization
Organization Name:AMERICAN HOME DOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-451-0600
Mailing Address - Street 1:8200 OLD 13 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2171
Mailing Address - Country:US
Mailing Address - Phone:586-510-4141
Mailing Address - Fax:586-510-4222
Practice Address - Street 1:8200 OLD 13 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2171
Practice Address - Country:US
Practice Address - Phone:586-510-4141
Practice Address - Fax:586-510-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN