| Organization Name: | PRIME CARE PHYSICIAN PC |
| NPI Number: | 1568635282 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GIRIJA MARIPUDI (OWNER) |
| Mailing Address: | 121 W 13 Mile Rd Madison Heights |
| State: | MI US |
| Postal Code: | 480711857 |
| Phone Number: | 2485830960 |
| Fax Number: | 2485830961 |
| NPI Enumeration Date: | 04/03/2008 |
| NPI Last Update Date: | 02/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301066341 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |