Healthcare Provider Details

I. General information

NPI: 1851752331
Provider Name (Legal Business Name): MERCY INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

42451 BEECHWOOD DR
STERLING HEIGHTS MI
48314-2943
US

V. Phone/Fax

Practice location:
  • Phone: 586-214-4556
  • Fax: 248-849-7448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301089948
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NABEEL SHABO
Title or Position: OWNER
Credential: MD
Phone: 586-214-4556