Provider Demographics
NPI:1740780873
Name:CARE MEDICAL CLINIC OF CANTON PLLC
Entity type:Organization
Organization Name:CARE MEDICAL CLINIC OF CANTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRINCAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-894-0763
Mailing Address - Street 1:5730 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3685
Mailing Address - Country:US
Mailing Address - Phone:218-410-1822
Mailing Address - Fax:
Practice Address - Street 1:5730 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3685
Practice Address - Country:US
Practice Address - Phone:218-410-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty