Healthcare Provider Details

I. General information

NPI: 1023233855
Provider Name (Legal Business Name): K & S FAMILY PRACTICE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S NEWBURGH RD
WAYNE MI
48184-1001
US

IV. Provider business mailing address

2901 S NEWBURGH RD
WAYNE MI
48184-1001
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-7220
  • Fax: 734-729-7227
Mailing address:
  • Phone: 734-729-7220
  • Fax: 734-729-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP406326
License Number StateMI

VIII. Authorized Official

Name: SUMAN PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 734-729-7220