Healthcare Provider Details

I. General information

NPI: 1053702506
Provider Name (Legal Business Name): ISMAIL B. SENDI, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 E 13 MILE RD
WARREN MI
48093-8700
US

IV. Provider business mailing address

6549 TOWN CENTER DR
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 586-825-9700
  • Fax: 586-825-9701
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN SENDI
Title or Position: EXECUTIVE VP OF OPERATIONS
Credential: JD, MBA
Phone: 248-467-9946