Healthcare Provider Details

I. General information

NPI: 1609811918
Provider Name (Legal Business Name): SPORTS MEDICINE ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37000 WOODWARD AVE SUITE 300
BLOOMFIELD HILLS MI
48304-0922
US

IV. Provider business mailing address

37000 WOODWARD AVE SUITE 300
BLOOMFIELD HILLS MI
48304-0922
US

V. Phone/Fax

Practice location:
  • Phone: 248-952-9200
  • Fax: 248-952-9201
Mailing address:
  • Phone: 248-952-9200
  • Fax: 248-952-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberSR056808
License Number StateMI

VIII. Authorized Official

Name: SAMI F RIFAT
Title or Position: MEMBER
Credential: M.D.
Phone: 248-952-9200