Provider Services

Home » Providers » Contact Provider Services » Provider Services

Provider Services

Please complete the form below and a Provider Services Representative will contact you.

* = REQUIRED FIELDS

Mr.Mrs.Ms.Dr.

*First Name:

*Last Name:

*Email Address:

Facility Name (optional)

*Practice Address:

City:

*State:

*Zip:

Daytime Phone #:

Extn:

How did you learn about the DMC Health Plans/DMC CARE Web Site?

What information are you looking for?

Did you find the information you were looking for?

Please click the following ( if applicable)

Would you like an application packet?
Would you like someone to telephone your office?

If you want someone to contact you, indicate the nature of the topic or problem:

Did you experience any problems while on the Web Site?

Was your visit to the WebSite of value to you?

Comments:

Security Code:

*Type Security Code:

DMC Care Customer Service
(800) 543-0161