Provider Demographics
NPI:1831232339
Name:BARBARA ANN CENTER FOR FAMILY MEDICINE
Entity type:Organization
Organization Name:BARBARA ANN CENTER FOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARVIN-LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-905-5470
Mailing Address - Street 1:1837 CAMPAU FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5167
Mailing Address - Country:US
Mailing Address - Phone:313-567-2704
Mailing Address - Fax:313-567-2704
Practice Address - Street 1:15565 NORTHLAND DR., STE 108E
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-905-5470
Practice Address - Fax:248-905-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty