Provider Demographics
NPI:1194187419
Name:ATCHOO MEDICAL PRACTICE, PLLC.
Entity type:Organization
Organization Name:ATCHOO MEDICAL PRACTICE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHOO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-383-8172
Mailing Address - Street 1:4515 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1172
Mailing Address - Country:US
Mailing Address - Phone:248-383-8172
Mailing Address - Fax:248-599-3963
Practice Address - Street 1:4515 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1172
Practice Address - Country:US
Practice Address - Phone:248-383-8172
Practice Address - Fax:248-599-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty