Organization
ADVANCED CARE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINQUE BUCK (OWNER)
(734) 728-5220
Entity
Organization
Contact information
Practice address
849 N WAYNE RD, WESTLAND, MI 48185-3690
(734) 728-5220
(734) 728-5269
Mailing address
20524 W WARREN AVE, DETROIT, MI 48228-3243
(313) 271-6660
(313) 271-9572
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H21822
BCBSM
MI
Enumeration date
02/07/2008
Last updated
02/07/2008
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