Healthcare Provider Details

I. General information

NPI: 1841940905
Provider Name (Legal Business Name): SCOPE MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PERRY ST
PONTIAC MI
48342-2217
US

IV. Provider business mailing address

6088 GLEN EAGLES DR
WEST BLOOMFIELD MI
48323-2212
US

V. Phone/Fax

Practice location:
  • Phone: 708-586-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHANAD SUEDE
Title or Position: OWNER
Credential: MD
Phone: 313-779-0406