Healthcare Provider Details

I. General information

NPI: 1558666891
Provider Name (Legal Business Name): ISMAIL B SENDI MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26522 VAN DYKE AVE
CENTER LINE MI
48015-1221
US

IV. Provider business mailing address

12850 FOUNTAIN SQ STE 106
DAVISBURG MI
48350-2552
US

V. Phone/Fax

Practice location:
  • Phone: 248-634-6303
  • Fax:
Mailing address:
  • Phone: 248-634-6303
  • Fax: 248-634-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ISMAIL B SENDI
Title or Position: EXECUTIVE MEDICAL DIRECTOR
Credential: MD
Phone: 248-634-6303