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General NPI Number Information
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NPI Number | 1083359913
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Entity Type | Organization
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Legal Business Name | METRO MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 11828 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3049
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Country | US
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Telephone | 313-707-0122
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Fax |
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Provider Business Mailing Address
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Address Line | 11828 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3049
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Country | US
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Telephone | 313-707-0122
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAYA R RAHMAN
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Credential |
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Telephone | 313-707-0122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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