Healthcare Provider Details

I. General information

NPI: 1851668123
Provider Name (Legal Business Name): PROFESSIONAL HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 GREENFIELD RD
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

2000 TOWN CTR SUITE 625
SOUTHFIELD MI
48075-1135
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-9470
  • Fax: 313-624-9471
Mailing address:
  • Phone: 248-440-7100
  • Fax: 248-850-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. SAMI AHMAD
Title or Position: MANAGER
Credential:
Phone: 313-624-9470