Healthcare Provider Details

I. General information

NPI: 1477707305
Provider Name (Legal Business Name): ROYAL HOME VISTING PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3985 CANIFF ST
HAMTRAMCK MI
48212-3184
US

IV. Provider business mailing address

3985 CANIFF ST
HAMTRAMCK MI
48212-3184
US

V. Phone/Fax

Practice location:
  • Phone: 313-368-0668
  • Fax: 313-368-0568
Mailing address:
  • Phone: 313-368-0668
  • Fax: 313-368-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4301039115
License Number StateMI

VIII. Authorized Official

Name: DR. MOHSEN DJAMALI
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 313-368-0668