Healthcare Provider Details

I. General information

NPI: 1396029161
Provider Name (Legal Business Name): DETROIT CLINICAL RESEARCH CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27780 NOVI RD SUITE 101
NOVI MI
48377-3401
US

IV. Provider business mailing address

27780 NOVI RD SUITE 101
NOVI MI
48377-3401
US

V. Phone/Fax

Practice location:
  • Phone: 248-773-8979
  • Fax: 248-468-1155
Mailing address:
  • Phone: 248-773-8979
  • Fax: 248-468-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number02264X
License Number StateMI

VIII. Authorized Official

Name: MAX RASHED
Title or Position: OWNER
Credential: MS, MBA
Phone: 248-773-8979