Provider Demographics
NPI:1952573248
Name:HOLY FAMILY CLINIC PLC
Entity Type:Organization
Organization Name:HOLY FAMILY CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA ADELA
Authorized Official - Middle Name:ASIS
Authorized Official - Last Name:CORDOBA-NAUGIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-423-5508
Mailing Address - Street 1:502 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2074
Mailing Address - Country:US
Mailing Address - Phone:517-423-5508
Mailing Address - Fax:517-423-4772
Practice Address - Street 1:502 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2074
Practice Address - Country:US
Practice Address - Phone:517-423-5508
Practice Address - Fax:517-423-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0804610351OtherBCBS
MI0N81860Medicare PIN