Provider Demographics
NPI:1609192467
Name:CITYMEDICAL CARE PC
Entity type:Organization
Organization Name:CITYMEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-245-9200
Mailing Address - Street 1:PO BOX 806464
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-6464
Mailing Address - Country:US
Mailing Address - Phone:313-245-9200
Mailing Address - Fax:313-245-9200
Practice Address - Street 1:11190 GRATIOT AVE
Practice Address - Street 2:A1
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1334
Practice Address - Country:US
Practice Address - Phone:313-245-9200
Practice Address - Fax:313-245-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center