Healthcare Provider Details

I. General information

NPI: 1306161781
Provider Name (Legal Business Name): PACCSA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57850 VAN DYKE RD SUITE 500
WASHINGTON MI
48094-3826
US

IV. Provider business mailing address

950 W AVON RD SUITE A2
ROCHESTER HILLS MI
48307-2761
US

V. Phone/Fax

Practice location:
  • Phone: 586-207-1247
  • Fax: 586-207-1264
Mailing address:
  • Phone: 248-651-6430
  • Fax: 248-650-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAZEN SABBAQ
Title or Position: M.D.
Credential: M.D.
Phone: 586-207-1247