Provider Demographics
NPI:1487723771
Name:C & M VISITING PHYSICIANS PLC
Entity type:Organization
Organization Name:C & M VISITING PHYSICIANS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-874-4436
Mailing Address - Street 1:2990 W GRAND BLVD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3041
Mailing Address - Country:US
Mailing Address - Phone:313-874-4436
Mailing Address - Fax:
Practice Address - Street 1:2990 W GRAND BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3041
Practice Address - Country:US
Practice Address - Phone:313-874-4436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144240458OtherJOHN MCCOLLOUGH MD
MI1770553521OtherALPHONSO BERRY MD
MI110H211060OtherBLUE CROSS BLUE SHIELD
MI1144240458OtherJOHN MCCOLLOUGH MD