Healthcare Provider Details

I. General information

NPI: 1285660571
Provider Name (Legal Business Name): SENIOR CARE MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 MICHIGAN AVE SUITE ONE
DEARBORN MI
48126-3491
US

IV. Provider business mailing address

15400 MICHIGAN AVE STE (1)
DEARBORN MI
48126
US

V. Phone/Fax

Practice location:
  • Phone: 313-584-3359
  • Fax: 313-584-1729
Mailing address:
  • Phone: 313-584-3359
  • Fax: 313-584-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License NumberKM171632
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License NumberMZ112158
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBA059825
License Number StateMI

VIII. Authorized Official

Name: DR. BELAL F ABDALLAH
Title or Position: OWNER
Credential: MD
Phone: 313-945-5450