# HOME CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HOME CLINIC PC
- **Other names:** Great Lakes Physicians of Southfield, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710202825
- **Legal business name:** HOME CLINIC PC
- **Authorized official:** PAUL PETRE MD (OWNER)
- **Authorized official phone:** (248) 223-1500

## Contact information

- **Practice address:** 23999 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-2578
- **Practice address phone:** (248) 223-1500
- **Mailing address:** 2980 N BEVERLY GLEN CIR, STE 301, LOS ANGELES, CA 90077-1726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 03/31/2010
- **Last updated:** 03/07/2011