Provider Demographics
NPI:1982869889
Name:FRIENDLY NEIGHBORHOOD MEDICAL CLINIC
Entity Type:Organization
Organization Name:FRIENDLY NEIGHBORHOOD MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-530-5884
Mailing Address - Street 1:14366 GRATIOT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2307
Mailing Address - Country:US
Mailing Address - Phone:313-526-7577
Mailing Address - Fax:313-526-7587
Practice Address - Street 1:14366 GRATIOT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2307
Practice Address - Country:US
Practice Address - Phone:313-526-7577
Practice Address - Fax:313-526-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherCOMMERCIAL