| Loon Lake Primary Care | |
|
1545 N Wixom Rd Wixom MI 48393-1411 | |
| (248) 833-6343 | |
| (248) 833-6343 |
| Full Name | Loon Lake Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 1545 N Wixom Rd, Wixom, Michigan |
| Authorized Official Name and Position | Paul S Shabou (OWNER) |
| Authorized Official Contact | 2488336343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loon Lake Primary Care 1545 N Wixom Rd Wixom MI 48393-1411 Ph: (248) 833-6343 | Loon Lake Primary Care 1545 N Wixom Rd Wixom MI 48393-1411 Ph: (248) 833-6343 |
| NPI Number | 1326890666 |
|---|---|
| Provider Enumeration Date | 04/02/2024 |
| Last Update Date | 05/24/2024 |
| Certification Date | 05/24/2024 |
| Medicare PECOS PAC ID | 2264874403 |
|---|---|
| Medicare Enrollment ID | O20240520003466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326890666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
| Provider Name | Paul S Shabou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346818846 PECOS PAC ID: 4587065628 Enrollment ID: I20240603002948 |
Responsive Visiting Physicians Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 49175 West Rd, Wixom, MI 48393 Phone: 248-487-8686 Fax: 248-694-2113 |
Recovery Mobile Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4706 Product Dr Ste 1, Wixom, MI 48393 Phone: 248-567-2334 |
Trinity Medical Consultants PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 49175 West Rd, Wixom, MI 48393 Phone: 248-487-8686 |