Provider Demographics
NPI:1447480744
Name:MICHIGAN HOME CARE PHYSICIANS
Entity type:Organization
Organization Name:MICHIGAN HOME CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:248-321-9050
Mailing Address - Street 1:18214 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3120
Mailing Address - Country:US
Mailing Address - Phone:248-321-9050
Mailing Address - Fax:
Practice Address - Street 1:18214 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3120
Practice Address - Country:US
Practice Address - Phone:248-321-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty