Organization
FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODRIGO TOBAR JR. DO (SECRETARY/TREASURER)
(248) 557-0535
Entity
Organization
Contact information
Practice address
29255 NORTHWESTERN HWY, SUITE 203, SOUTHFIELD, MI 48034-1018
(248) 557-0535
(248) 557-6145
Mailing address
29255 NORTHWESTERN HWY, SUITE 203, SOUTHFIELD, MI 48034-1018
(248) 557-0535
(248) 557-6145
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RT008998
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008750
DETROIT MEDICAL CENTER
MI
01
—
0638787
PIN NUMBER
MI
01
—
080165831
PALMETTO GBA
MI
01
—
080F364760
BCBS
MI
05
—
2691080
—
MI
01
—
5630421
PIN NUMBER
MI
Enumeration date
02/14/2006
Last updated
01/18/2012
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