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NPI Code Detail

MEDICARE: PROFESSIONAL HEALTH CARE PROVIDERS

MEDICARE: PROFESSIONAL HEALTH CARE PROVIDERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician5101008983MI

General Provider Information

NPI Number : 1427232057
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL HEALTH CARE PROVIDERS
Provider Business Mailing Address
First Line : 2011 MIDDLEBELT RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-2819
Country : US
Telephone Number : 313-610-6659
Fax Number : 734-367-1214
Provider Business Practice Location Address
First Line : 2011 MIDDLEBELT RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-2819
Country : US
Telephone Number : 313-610-6659
Fax Number : 734-367-1214
Authorized Official
Title or Position : PRESIDENT
Name : HOUSAM FADLALLAH
Credential : P.A.C.
Telephone Number : 313-610-6659
Provider Enumeration Date : 12/18/2007
Last Update Date : 12/18/2007

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Directions to “PROFESSIONAL HEALTH CARE PROVIDERS ” Practice Location

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