NPI 1417384199

Farmbrook Family Practice PLLC

Organisation Health Maintenance Organization Southfield, MI

Practice location

Address: 29877 Telegraph Rd Suite 302, Southfield, MI 48034-1332
Phone: (248) 796-7486
Fax: (248) 350-3519
Mailing address: 23688 Paddock Dr, Farmington Hills, MI 48336-2226

Authorised official

Name: Andrei Katychev
Title: Owner
Phone: (248) 470-6038

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 4301085733 (MI)

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Registry record

NPI: 1417384199
Entity type: Organization
NPI issued: 26 Sep 2013
Record last updated: 28 Apr 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.