=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144562083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED HEALTH GROUP, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2013
-----------------------------------------------------
Last Update Date | 03/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 GREENFIELD RD
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-624-9470
-----------------------------------------------------
Fax | 313-624-9471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19785 W 12 MILE RD SUITE 679
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-514-2342
-----------------------------------------------------
Fax | 248-443-0165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HUSSEIN HURAIBI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 313-565-6782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------