Healthcare Provider Details

I. General information

NPI: 1962696831
Provider Name (Legal Business Name): SYNERGY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23337 WOODWARD AVE
FERNDALE MI
48220-1362
US

IV. Provider business mailing address

23337 WOODWARD AVE
FERNDALE MI
48220-1362
US

V. Phone/Fax

Practice location:
  • Phone: 248-545-4852
  • Fax:
Mailing address:
  • Phone: 248-545-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NISHATH KHURSHID HAKIM
Title or Position: OWNER
Credential: MD
Phone: 248-545-4852