| Organization Name: | GLADWIN FAMILY CARE CENTER P C |
| NPI Number: | 1104931211 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HICHAM CHURBAJI (PRESIDENT) |
| Mailing Address: | 2137 W M61 Gladwin |
| State: | MI US |
| Postal Code: | 48624 |
| Phone Number: | 9894269399 |
| Fax Number: | 9892462257 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 11/01/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |