Family & Sports Medical Center

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

RG008180 Issued in MI

Legal business name

FAMILY & SPORTS MEDICAL CENTER

Practice address

965 S Main St
Plymouth, MI 48170-2048

Phone

(734) 455-2970

Fax

(313) 561-0277

NPI assigned

Jul 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Gordon, DO

Title

Owner/Physician

Phone

(734) 455-2970

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Shylaja Gontina-Khatiwala, MD

  • Addiction Medicine (Family Medicine) Physician
  • South Lyon, MI
  • NPI 1205836137
  NPD (past)
• Susan Beth Tam, DO

  • Family Medicine Physician
  • Ferndale, MI
  • NPI 1801873237
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740280676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 S MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702048",
            "telephone_number": "734-455-2970",
            "fax_number": "313-561-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 S MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702048",
            "telephone_number": "734-455-2970",
            "fax_number": "313-561-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & SPORTS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "734-455-2970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "RG008180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Lin-Butterfield Fairbanks, RN
• Stacey Fairman
• Mallorie Falatovich
• Julie Beth Falbaum, MSW LMSW ACSW CAC-1
• Erin Falcon
• Family Home Health Services, Inc.
• Family Home Physicians LLC
• Family Home Physicians, PC
• Angelica Fandino
• Samuel K Fandino, DDS

• Sports Medicine (Family Medicine) Physician in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Sports Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.