Healthcare Provider Details

I. General information

NPI: 1003137274
Provider Name (Legal Business Name): FAMILY MEDICINE AND SLEEP SPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 MARTIN RD
WARREN MI
48093-4511
US

IV. Provider business mailing address

11670 MARTIN RD
WARREN MI
48093-4511
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-3830
  • Fax: 586-754-3840
Mailing address:
  • Phone: 586-754-3830
  • Fax: 586-754-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301053641
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301053641
License Number StateMI

VIII. Authorized Official

Name: ASIMA HUSSAIN
Title or Position: OWNER
Credential: M.D.
Phone: 586-754-3830