Provider Demographics
NPI:1699883819
Name:S E MICHIGAN FAMILY PRACTICE PC
Entity type:Organization
Organization Name:S E MICHIGAN FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-399-3550
Mailing Address - Street 1:350 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2531
Mailing Address - Country:US
Mailing Address - Phone:248-399-3550
Mailing Address - Fax:248-399-6136
Practice Address - Street 1:350 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2531
Practice Address - Country:US
Practice Address - Phone:248-399-3550
Practice Address - Fax:248-399-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEF055658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0156312614OtherBC
MI470701711Medicaid
MIEF055658OtherLICENSE #
MIE25802OtherHAP
MI0F33895OtherBCBSM
MI124302OtherCARE CHOICES
MI0F33895OtherBCBSM
MIEF055658OtherLICENSE #
MIE25802Medicare UPIN