HOME CLINIC PC (NPI# 1710202825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710202825 |
| Entity Type | Organization |
| Organization Name | HOME CLINIC PC |
| Other Organization Name | GREAT LAKES PHYSICIANS OF SOUTHFIELD, LLC |
| Practice Address |
23999 Northwestern Hwy Southfield MI 48075-2578 |
| Mailing Address |
2980 N Beverly Glen Cir Ste 301 Los Angeles CA 90077-1726 |
| Practice Telephone | 2482231500 |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2011-03-07 |
| Authorized Official Name | PAUL PETRE (OWNER) |
| Authorized Official Telephone | 2482231500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | HOME CLINIC PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PTAN | MI1676 | 01 |
| Other Name | Type Code |
|---|---|
| Great Lakes Physicians of Southfield, LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962645689 | Home Clinic PC | General Practice | 23999 Northwestern Hwy, Suite 110, Southfield, MI 48075-2578 | 2009-04-10 |
| Street Address |
23999 NORTHWESTERN HWY |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-2578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336191584 | Quality Foot & Ankle Clinic | Durable Medical Equipment & Medical Supplies | 23999 Northwestern Hwy, Suite 220, Southfield, MI 48075-2578 | 2006-05-16 |
| 1255786661 | Southfield Rehab Center Inc | Clinic/Center | 23999 Northwestern Hwy, Suite 161, Southfield, MI 48075-2578 | 2016-05-04 |
| 1629449152 | Urban Health Care Group Pllc | Podiatrist | 23999 Northwestern Hwy, Ste 220, Southfield, MI 48075-2578 | 2015-10-09 |
| 1790161313 | Shazia Malik | Podiatrist | 23999 Northwestern Hwy, Suite 220, Southfield, MI 48075 | 2015-08-05 |
| 1144647686 | Benevolent Health Care Clinic | Specialist | 23999 Northwestern Hwy, Ste 114, Southfield, MI 48075-2578 | 2014-03-22 |
| 1295173094 | Rachel Kimberly Stabel | Registered Nurse | 23999 Northwestern Hwy, Southfield, MI 48075-2578 | 2013-06-13 |
| 1003181363 | Ark Health LLC | General Practice | 23999 Northwestern Hwy, Southfield, MI 48075-2578 | 2012-03-19 |
| 1003192568 | Ashtiaq Khokhar | Physical Therapist | 23999 Northwestern Hwy, Southfield, MI 48075-2578 | 2011-10-28 |
| 1447536909 | Southfield Rehabilitation Center Inc | Clinic/Center | 23999 Northwestern Hwy, Southfield, MI 48075-2578 | 2011-10-28 |
| 1326327230 | Northwestern Rehabilitation Services. LLC | Clinic/Center | 23999 Northwestern Hwy, Suite 105, Southfield, MI 48075-2578 | 2011-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720559792 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 11012 E 13 Mile Rd Ste 201, Warren, MI 48093-2547 | 2018-12-17 |
| 1811468184 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 18245 E 10 Mile Rd Ste 130, Roseville, MI 48066-5807 | 2018-12-16 |
| 1407327778 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 3100 Cross Creek Pkwy Ste 150, Auburn Hills, MI 48326-2777 | 2018-12-16 |
| 1003332271 | Wrs Pharmacy Solutions, LLC | Non-Pharmacy Dispensing Site | 112 S Main St Ste A, Ann Arbor, MI 48104-1953 | 2017-08-18 |
| 1457759144 | Perfect Eyes Optical LLC | Non-Pharmacy Dispensing Site | 20880 Gratiot Ave, Eastpointe, MI 48021-2822 | 2014-12-11 |
| 1346478740 | Pristine Medical LLC | Non-Pharmacy Dispensing Site | 1502 W West Maple Rd, Walled Lake, MI 48390-2945 | 2009-06-24 |
| 1801910807 | Wolverine Optical Inc | Non-Pharmacy Dispensing Site | 7314 N Alger Rd, Alma, MI 48801-1072 | 2007-03-17 |
| 1255439253 | Anthony J Derrico Do | Non-Pharmacy Dispensing Site | Cancer Care Associates PC, 1701 S Blvd East Ste 350, Rochester Hills, MI 48307 | 2006-09-21 |
| 1336246263 | Clinical Oncology Associates | Non-Pharmacy Dispensing Site | 30160 Orchard Lake Rd, Ste 100, Farmington Hills, MI 48334-2293 | 2006-09-20 |
| 1730124934 | Northpointe Pediatrics PC | Non-Pharmacy Dispensing Site | 30061 Schoenherr Rd, Ste A, Warren, MI 48088-3133 | 2006-06-19 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.