Provider Demographics
NPI:1487775417
Name:ADULT PRIMARY CARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:ADULT PRIMARY CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEATHCARE PROVIDER OF ADULT P
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN-BC
Authorized Official - Phone:248-360-6600
Mailing Address - Street 1:8896 COMMERCE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4494
Mailing Address - Country:US
Mailing Address - Phone:248-360-6600
Mailing Address - Fax:248-360-6601
Practice Address - Street 1:8896 COMMERCE RD STE 4
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4494
Practice Address - Country:US
Practice Address - Phone:248-360-6600
Practice Address - Fax:248-360-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION71740Medicare ID - Type Unspecified