Provider Demographics
NPI:1104074582
Name:FRIENDLY NEIGHBORHOOD MEDICAL CLINIC II
Entity type:Organization
Organization Name:FRIENDLY NEIGHBORHOOD MEDICAL CLINIC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-273-2000
Mailing Address - Street 1:18606 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2315
Mailing Address - Country:US
Mailing Address - Phone:313-273-2000
Mailing Address - Fax:313-273-2020
Practice Address - Street 1:18606 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2315
Practice Address - Country:US
Practice Address - Phone:313-273-2000
Practice Address - Fax:313-273-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty