Provider Demographics
NPI:1104889773
Name:COUNTRY CREEK FAMILY PHYSICIANS
Entity type:Organization
Organization Name:COUNTRY CREEK FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUOCYS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-475-4301
Mailing Address - Street 1:4986 ADAMS RD
Mailing Address - Street 2:STE A
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-4301
Mailing Address - Fax:248-475-4305
Practice Address - Street 1:4986 ADAMS RD
Practice Address - Street 2:STE A
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-4301
Practice Address - Fax:248-475-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F32698OtherBCBS
0P22250Medicare ID - Type Unspecified