Organization
MID MICHIGAN HOME VISITING DOCTORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY OMAR (VICE PRESIDENT)
(313) 862-8050
Entity
Organization
Contact information
Practice address
640 ROMENCE RD, SUITE 215, PORTAGE, MI 49024-3464
(269) 321-3300
Mailing address
PO BOX 40420, REDFORD, MI 48240-0420
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/01/2010
Last updated
12/01/2011
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