Healthcare Provider Details

I. General information

NPI: 1043750136
Provider Name (Legal Business Name): WESTBORN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23865 MICHIGAN AVE
DEARBORN MI
48124-1805
US

IV. Provider business mailing address

23865 MICHIGAN AVE
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-562-9588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4704295266
License Number StateMI

VIII. Authorized Official

Name: RICHARD HAMMOUD
Title or Position: DOCTOR
Credential:
Phone: 313-562-9588