Healthcare Provider Details

I. General information

NPI: 1962555227
Provider Name (Legal Business Name): GREAT LAKES INTERNIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35000 DIVISION RD SUITE 9
RICHMOND MI
48062-1566
US

IV. Provider business mailing address

35000 DIVISION RD SUITE 9
RICHMOND MI
48062-1566
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-8606
  • Fax:
Mailing address:
  • Phone: 586-727-7209
  • Fax: 586-727-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065345
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301065345
License Number StateMI

VIII. Authorized Official

Name: DR. MOUHAMAD F RIHAWI
Title or Position: PRESIDENT
Credential: MD
Phone: 586-727-7209