Provider Demographics
NPI:1932825668
Name:MICHIGAN CARE MANAGEMENT SOLUTIONS LLC
Entity Type:Organization
Organization Name:MICHIGAN CARE MANAGEMENT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-894-8905
Mailing Address - Street 1:1800 IROQUOIS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2748
Mailing Address - Country:US
Mailing Address - Phone:248-894-8905
Mailing Address - Fax:
Practice Address - Street 1:24124 GREENFIELD RD
Practice Address - Street 2:STE 306
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:313-348-0607
Practice Address - Fax:313-447-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic CareGroup - Single Specialty