Provider Demographics
NPI:1932788577
Name:GLADWIN FAMILY CARE PLLC
Entity Type:Organization
Organization Name:GLADWIN FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHFOOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-672-2100
Mailing Address - Street 1:673 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2215
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:673 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-2215
Practice Address - Country:US
Practice Address - Phone:989-791-2455
Practice Address - Fax:989-791-1392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLADWIN FAMILY CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9216OtherMEDICARE