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Organization
HOME CLINIC PC
Active
Organization
HOME CLINIC PC
Active
Parent organization
HOME CLINIC PC
Other names
Great Lakes Physicians of Southfield, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOME CLINIC PC
Authorized official
PAUL PETRE MD (OWNER)
(248) 223-1500
Entity
Organization
Contact information
Practice address
23999 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-2578
(248) 223-1500
Mailing address
2980 N BEVERLY GLEN CIR, STE 301, LOS ANGELES, CA 90077-1726
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
NULL
Other
Enumeration date
03/31/2010
Last updated
03/07/2011
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