Provider Demographics
NPI:1487349510
Name:PATIENT CENTERED FAMILY MEDICINE & OMT
Entity type:Organization
Organization Name:PATIENT CENTERED FAMILY MEDICINE & OMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:ANDERSONNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-924-4884
Mailing Address - Street 1:55275 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9158
Mailing Address - Country:US
Mailing Address - Phone:248-924-4884
Mailing Address - Fax:
Practice Address - Street 1:9960 VILLAGE PLACE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2089
Practice Address - Country:US
Practice Address - Phone:248-869-6500
Practice Address - Fax:248-869-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty