# MID MICHIGAN HOME VISITING DOCTORS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790092500
- **Authorized official:** MR. JERRY OMAR (VICE PRESIDENT)
- **Authorized official phone:** (313) 862-8050

## Contact information

- **Practice address:** 640 ROMENCE RD, SUITE 215, PORTAGE, MI 49024-3464
- **Practice address phone:** (269) 321-3300
- **Mailing address:** PO BOX 40420, REDFORD, MI 48240-0420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2010
- **Last updated:** 12/01/2011