Provider Demographics
NPI:1972699312
Name:MONROE MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:MONROE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-288-7814
Mailing Address - Street 1:8759 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429
Mailing Address - Country:US
Mailing Address - Phone:989-288-7814
Mailing Address - Fax:989-288-7818
Practice Address - Street 1:8759 MONROE RD
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429
Practice Address - Country:US
Practice Address - Phone:989-288-7814
Practice Address - Fax:989-288-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM066182207Q00000X
MIRN004783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty