Healthcare Provider Details

I. General information

NPI: 1427962679
Provider Name (Legal Business Name): SPORTS MEDICINE AND PAIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25614 FORD RD
DEARBORN HEIGHTS MI
48127-3024
US

IV. Provider business mailing address

25614 FORD RD
DEARBORN HEIGHTS MI
48127-3024
US

V. Phone/Fax

Practice location:
  • Phone: 313-354-3544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAREK HADLA
Title or Position: OWNER
Credential:
Phone: 313-354-3544