Provider Demographics
NPI:1992086680
Name:COMPREHENSIVE FAMILY HEALTHCARE PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ENGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:2486-200-3777
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-620-0377
Mailing Address - Fax:248-620-0385
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:STE 202
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-620-0377
Practice Address - Fax:248-620-0385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CFH URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITE007018207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4861124Medicaid
MI0F34006OtherBCBS
MIB49556Medicare UPIN
MI4861124Medicaid