Organization
FARMBROOK FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREI KATYCHEV M.D. (OWNER)
(248) 470-6038
Entity
Organization
Contact information
Practice address
29877 TELEGRAPH RD, SUITE 302, SOUTHFIELD, MI 48034-1332
(248) 796-7486
(248) 350-3519
Mailing address
23688 PADDOCK DR, FARMINGTON HILLS, MI 48336-2226
(248) 796-7486
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
4301085733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417384199
—
MI
Enumeration date
09/26/2013
Last updated
04/28/2016
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