Provider Demographics
NPI:1104536069
Name:MI FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:MI FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACUTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-228-6290
Mailing Address - Street 1:23985 NOVI RD STE B102
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5436
Mailing Address - Country:US
Mailing Address - Phone:248-983-1130
Mailing Address - Fax:
Practice Address - Street 1:23985 NOVI RD STE B102
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5436
Practice Address - Country:US
Practice Address - Phone:248-983-1130
Practice Address - Fax:833-983-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty