MEDICARE: HMC GROUP

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1750864559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HMC GROUP

Provider Business Mailing Address
First Line	:	6100 DOROTHY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1566
Country	:	US
Telephone Number	:	313-921-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 DOROTHY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1566
Country	:	US
Telephone Number	:	313-921-5881
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RAGHDA IMAM
Credential	:	MD
Telephone Number	:	313-921-5881

Provider Enumeration Date	:	09/08/2018
Last Update Date	:	09/08/2018

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