AMC Primary Care & Consultants PLLC

Organization Active NPI Internal Medicine Physician · Dearborn HTS, MI

NPI 1356093462 · NPPES record last updated Jan 20, 2022

Key facts

NPI
1356093462
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
AMC PRIMARY CARE & CONSULTANTS PLLC
Practice address
23850 Van Born Rd
Dearborn HTS, MI 48125-2325
Phone
(313) 578-1911
NPI assigned
Jan 20, 2022
Organization subpart
No

Authorized official

Name
Amera Gobah
Title
Authorized Official
Phone
(313) 578-1911

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20220304000812 MI Part B Supplier - Clinic/Group Practice 6800280090 Receives reassigned benefits from 3 practitioners
Practice locations: Dearborn Heights, MI; Southgate, MI

National Provider Directory

Locations

23850 Van Born Rd
Ste A
Dearborn Heights, MI 48125
Phone (313) 578-1911

13650 Fort St
Southgate, MI 48195
Phone (734) 281-2150

13560 Ft St
Southgate, MI 48195

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207R00000X Yes

Addresses

Primary practice location

23850 Van Born Rd
Dearborn HTS, MI 48125-2325

Mailing address

23850 Van Born Rd
Dearborn HTS, MI 48125-2325
Phone (313) 578-1911

Other identifiers

IdentifierTypeStateIssuer
PENDINGMedicaidMI

Electronic endpoints

TypeEndpointUseAffiliation
Other URL DEARBORNHEIGHTS Other

Other providers in Dearborn HTS, MI

All providers in Dearborn HTS, MI · Internal Medicine Physician in Michigan

Sources for this page

Verify at the official NPI Registry.