Healthcare Provider Details

I. General information

NPI: 1487745634
Provider Name (Legal Business Name): REDEEMER FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 JUNCTION ST
DETROIT MI
48209-2110
US

IV. Provider business mailing address

1700 JUNCTION ST
DETROIT MI
48209-2110
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-5500
  • Fax: 313-841-5501
Mailing address:
  • Phone: 313-841-5500
  • Fax: 313-841-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NABEEL TOMA
Title or Position: PRESIDENT
Credential: MD
Phone: 313-841-5500