Healthcare Provider Details

I. General information

NPI: 1558500744
Provider Name (Legal Business Name): MILLENNIUM MEDICAL GROUP SOUTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 TELEGRAPH RD
TAYLOR MI
48180-2316
US

IV. Provider business mailing address

8850 TELEGRAPH RD
TAYLOR MI
48180-2316
US

V. Phone/Fax

Practice location:
  • Phone: 313-299-2360
  • Fax: 313-299-2362
Mailing address:
  • Phone: 313-299-2360
  • Fax: 313-299-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABRAHAM SLAIM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 313-295-3388