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General NPI Number Information
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NPI Number | 1366552804
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Entity Type | Organization
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Legal Business Name | AMERICAN INDIAN HEALTH AND FAMILY SERVICES OF SOUTHEASTERN MI INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 4880 LAWNDALESTREET
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City | DETROIT
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State | MI
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Zip | 48210
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Country | US
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Telephone | 313-846-3718
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Fax | 313-846-0150
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Provider Business Mailing Address
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Address Line | PO BOX 810
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City | DEARBORN
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State | MI
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Zip | 48121
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Country | US
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Telephone | 313-846-3718
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Fax | 313-846-0150
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | WANETA ASSAF
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Credential |
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Telephone | 313-846-3718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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