Provider Demographics
NPI:1801377833
Name:FAMILY MEDICINE & ADULT CARE LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE & ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MTANIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-747-3220
Mailing Address - Street 1:2631 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8539
Mailing Address - Country:US
Mailing Address - Phone:614-747-3220
Mailing Address - Fax:
Practice Address - Street 1:2330 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1371
Practice Address - Country:US
Practice Address - Phone:937-505-9501
Practice Address - Fax:937-505-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty