Provider Demographics
NPI:1912710609
Name:MICHIGAN FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:MICHIGAN FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAZMA
Authorized Official - Middle Name:KHAN
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-857-7878
Mailing Address - Street 1:2167 ORCHARD LAKE ROAD
Mailing Address - Street 2:SUITE-B
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320
Mailing Address - Country:US
Mailing Address - Phone:248-857-7878
Mailing Address - Fax:248-857-7888
Practice Address - Street 1:2167 ORCHARD LAKE ROAD
Practice Address - Street 2:SUITE-B
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320
Practice Address - Country:US
Practice Address - Phone:248-857-7878
Practice Address - Fax:248-857-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI803248117Medicaid