Healthcare Provider Details

I. General information

NPI: 1861510968
Provider Name (Legal Business Name): INTEGRATED HEALTH CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD SUITE 2140
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD SUITE 2140
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-5050
  • Fax: 248-669-1700
Mailing address:
  • Phone: 248-669-5050
  • Fax: 248-669-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301081351
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301076848
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301076848
License Number StateMI

VIII. Authorized Official

Name: DR. SUZAN MOKHAYESH SYED
Title or Position: CO-PRESIDENT
Credential: MD
Phone: 248-669-5050