Healthcare Provider Details

I. General information

NPI: 1568028801
Provider Name (Legal Business Name): COMPLEX CARE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6045 W PIERSON RD
FLUSHING MI
48433-2389
US

IV. Provider business mailing address

30700 TELEGRAPH RD
BINGHAM FARMS MI
48025-4524
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-1331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA EL MASRI
Title or Position: BILLING MANAGER
Credential:
Phone: 248-215-0048