Healthcare Provider Details

I. General information

NPI: 1629953567
Provider Name (Legal Business Name): ENSPA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34020 7 MILE RD STE 101
LIVONIA MI
48152-3093
US

IV. Provider business mailing address

1221 BOWERS ST UNIT 940
BIRMINGHAM MI
48012-7037
US

V. Phone/Fax

Practice location:
  • Phone: 248-480-5424
  • Fax:
Mailing address:
  • Phone: 313-443-8942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAZEM ELTAHAWY
Title or Position: PRESIDENT
Credential: MD
Phone: 313-443-8942