Healthcare Provider Details

I. General information

NPI: 1225564271
Provider Name (Legal Business Name): SUMMIT TOTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23350 GREENFIELD RD STE 200
OAK PARK MI
48237-2496
US

IV. Provider business mailing address

23350 GREENFIELD RD STE 200
OAK PARK MI
48237-2496
US

V. Phone/Fax

Practice location:
  • Phone: 248-808-6225
  • Fax:
Mailing address:
  • Phone: 248-808-6225
  • 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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301102602
License Number StateMI

VIII. Authorized Official

Name: SAHAR HASSANE
Title or Position: MANAGER
Credential:
Phone: 586-598-8115