Healthcare Provider Details

I. General information

NPI: 1598202467
Provider Name (Legal Business Name): MERCY FAMILY CARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4091 CHATWAL CT
TROY MI
48085-0001
US

IV. Provider business mailing address

4091 CHATWAL CT
TROY MI
48085-0001
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-4206
  • Fax:
Mailing address:
  • Phone: 248-854-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301094540
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301092314
License Number StateMI

VIII. Authorized Official

Name: DR. RAAD AL-KHOURI
Title or Position: OWNER
Credential: M.D.
Phone: 248-854-4206