MEDICARE: FIRST CHOICE MEDICAL GROUP PLLC

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1750769394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	23455 MICHIGAN AVE
Second Line	:	SUITE B
City	:	DEARBORN
State	:	MI
Zip	:	48124-1908
Country	:	US
Telephone Number	:	313-757-7207
Fax Number	:	313-438-6094

Provider Business Practice Location Address
First Line	:	23455 MICHIGAN AVE
Second Line	:	SUITE B
City	:	DEARBORN
State	:	MI
Zip	:	48124-1908
Country	:	US
Telephone Number	:	313-757-7207
Fax Number	:	313-438-6094

Authorized Official
Title or Position	:	MD
Name	:	DR. ALI M HASSAN
Credential	:	MD
Telephone Number	:	313-757-7207

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	01/04/2016

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