Healthcare Provider Details

I. General information

NPI: 1396046587
Provider Name (Legal Business Name): MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WILKINS ST
DETROIT MI
48207-4802
US

IV. Provider business mailing address

1320 WILKINS ST
DETROIT MI
48207-4802
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-2150
  • Fax:
Mailing address:
  • Phone: 313-656-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301033492
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301033492
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number4301024834
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number4301024834
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301024834
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301024834
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301024834
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number4301024834
License Number StateMI

VIII. Authorized Official

Name: DR. ZEIA RUEDA CASAB SR.
Title or Position: PHYSICIAN
Credential: M.D,
Phone: 248-247-5869