Healthcare Provider Details

I. General information

NPI: 1578716668
Provider Name (Legal Business Name): LAMIS KOBEISSI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 510
DETROIT MI
48201-2021
US

IV. Provider business mailing address

4160 JOHN R ST STE 510
DETROIT MI
48201-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax: 313-993-2563
Mailing address:
  • Phone: 313-993-7777
  • Fax: 313-993-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: