| Housecall Physicians Of Southwest Michigan Plc | |
|
5084 Lovers Ln Portage MI 49002-1557 | |
| (269) 327-3700 | |
| (269) 323-0229 |
| Full Name | Housecall Physicians Of Southwest Michigan Plc |
|---|---|
| Speciality | General Practice |
| Location | 5084 Lovers Ln, Portage, Michigan |
| Authorized Official Name and Position | Bahram Elami (SINGLE MEMBER) |
| Authorized Official Contact | 2693273700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Housecall Physicians Of Southwest Michigan Plc Po Box 1147 Portage MI 49081-1147 Ph: (269) 327-3700 | Housecall Physicians Of Southwest Michigan Plc 5084 Lovers Ln Portage MI 49002-1557 Ph: (269) 327-3700 |
| NPI Number | 1669682951 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 07/31/2014 |
| Medicare PECOS PAC ID | 3072684331 |
|---|---|
| Medicare Enrollment ID | O20080616000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669682951 | NPI | - | NPPES |
| 340020811 | Other | MI | MEDICARE RAIL ROAD |
| 4421824 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 4301068834 (Michigan) | Primary |
| Provider Name | Bahram Elami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326124090 PECOS PAC ID: 3072684323 Enrollment ID: I20080616000012 |
| Provider Name | Sheryl Ann Newton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134694292 PECOS PAC ID: 6204249741 Enrollment ID: I20201230001810 |
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