Healthcare Provider Details

I. General information

NPI: 1821212606
Provider Name (Legal Business Name): LTACH SPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

29407 WEATHERVANE AVE
FARMINGTON HILLS MI
48331-2813
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-4797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4301059699
License Number StateMI

VIII. Authorized Official

Name: DR. MUHAMMAD Y KARIM
Title or Position: OWNER
Credential: M.D.
Phone: 313-745-0203