Healthcare Provider Details

I. General information

NPI: 1760682371
Provider Name (Legal Business Name): ACCESS IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 MAPLE
DEARBORN MI
48126
US

IV. Provider business mailing address

2651 SAULINO CT
DEARBORN MI
48209
US

V. Phone/Fax

Practice location:
  • Phone: 313-216-2230
  • Fax: 313-584-3206
Mailing address:
  • Phone: 313-842-7010
  • Fax: 313-842-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301087179
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301067792
License Number StateMI

VIII. Authorized Official

Name: HASSAN DAKROUB
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 313-216-2230