Healthcare Provider Details

I. General information

NPI: 1295096345
Provider Name (Legal Business Name): HOPE PRIMARY CARE ROMULUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9171 LAPEER RD
DAVISON MI
48423-3617
US

IV. Provider business mailing address

9340 WAYNE RD
ROMULUS MI
48174-1569
US

V. Phone/Fax

Practice location:
  • Phone: 810-412-5590
  • Fax: 810-412-5593
Mailing address:
  • Phone: 810-412-5590
  • Fax: 810-412-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301056997
License Number StateMI

VIII. Authorized Official

Name: NUSRAT JAVAID
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 810-412-5590