Provider Demographics
NPI:1518076306
Name:ANCHOR BAY CLINIC-FAMILY MEDICAL CENTER, P.C.
Entity type:Organization
Organization Name:ANCHOR BAY CLINIC-FAMILY MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-725-8500
Mailing Address - Street 1:32901 23 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4063
Mailing Address - Country:US
Mailing Address - Phone:586-725-8500
Mailing Address - Fax:586-725-5311
Practice Address - Street 1:32901 23 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4063
Practice Address - Country:US
Practice Address - Phone:586-725-8500
Practice Address - Fax:586-725-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1380281Medicaid
MI3176895Medicaid
MI4115482Medicaid
MI2770058Medicaid
MI1639308398Medicaid
MI3176895Medicaid
MI0E06195005Medicare PIN
MIE26823Medicare UPIN
MIE26247Medicare UPIN
MI0E06195002Medicare PIN
MI0E06195001Medicare PIN
MIG96087Medicare UPIN
MI1380281Medicaid
MI0E01695004Medicare PIN
MIF05083Medicare UPIN