Healthcare Provider Details

I. General information

NPI: 1144659467
Provider Name (Legal Business Name): SPARTAN SURGICAL ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24530 MICHIGAN AVE
DEARBORN MI
48124-1700
US

IV. Provider business mailing address

24530 MICHIGAN AVE
DEARBORN MI
48124-1700
US

V. Phone/Fax

Practice location:
  • Phone: 313-585-9282
  • Fax:
Mailing address:
  • Phone: 313-585-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101016167
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101016096
License Number StateMI

VIII. Authorized Official

Name: NOUHA ALAMMAR
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 313-622-6879