Healthcare Provider Details

I. General information

NPI: 1144237082
Provider Name (Legal Business Name): ENDOCRINE & DIABETES CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CROOKS RD SUITE A
ROCHESTER HILLS MI
48309-3609
US

IV. Provider business mailing address

2970 CROOKS RD SUITE A
ROCHESTER HILLS MI
48309-3609
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-1873
  • Fax: 248-844-0219
Mailing address:
  • Phone: 248-844-1873
  • Fax: 248-844-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301062353
License Number StateMI

VIII. Authorized Official

Name: ABDULSALAM AL-KASSAB
Title or Position: OWNER
Credential: MD
Phone: 248-844-1873