Provider Demographics
NPI:1427155985
Name:COMPREHENSIVE MEDICAL CARE
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ENGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-620-0377
Mailing Address - Street 1:5710 BELLA ROSE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4773
Mailing Address - Country:US
Mailing Address - Phone:248-620-0377
Mailing Address - Fax:248-620-0385
Practice Address - Street 1:5710 BELLA ROSE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4773
Practice Address - Country:US
Practice Address - Phone:248-620-0377
Practice Address - Fax:248-620-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITE007018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4861124Medicaid
MI0856314034OtherBCBSM
B49556Medicare UPIN
MI0856314034OtherBCBSM