Healthcare Provider Details

I. General information

NPI: 1649451964
Provider Name (Legal Business Name): CEDAR MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 MONROE ST
DEARBORN MI
48124-2916
US

IV. Provider business mailing address

1951 MONROE ST
DEARBORN MI
48124-2916
US

V. Phone/Fax

Practice location:
  • Phone: 313-563-5757
  • Fax: 313-563-5760
Mailing address:
  • Phone: 313-563-5757
  • Fax: 313-563-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberGG078483
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberGG078483
License Number StateMI

VIII. Authorized Official

Name: DR. GHADI G GHORAYEB
Title or Position: OWNER
Credential: MD
Phone: 313-563-5757