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General NPI Number Information
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NPI Number | 1306161781
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Entity Type | Organization
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Legal Business Name | PACCSA, L.L.C.
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 57850 VAN DYKE RD SUITE 500
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City | WASHINGTON
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State | MI
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Zip | 48094-3826
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Country | US
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Telephone | 586-207-1247
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Fax | 586-207-1264
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Provider Business Mailing Address
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Address Line | 950 W AVON RD SUITE A2
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-2761
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Country | US
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Telephone | 248-651-6430
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Fax | 248-650-1382
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Authorized Official
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Title or Position | M.D.
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Name | MAZEN SABBAQ
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Credential | M.D.
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Telephone | 586-207-1247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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