Healthcare Provider Details

I. General information

NPI: 1366552804
Provider Name (Legal Business Name): AMERICAN INDIAN HEALTH AND FAMILY SERVICES OF SOUTHEASTERN MI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LAWNDALESTREET
DETROIT MI
48210
US

IV. Provider business mailing address

PO BOX 810
DEARBORN MI
48121
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-3718
  • Fax: 313-846-0150
Mailing address:
  • Phone: 313-846-3718
  • Fax: 313-846-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WANETA ASSAF
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 313-846-3718