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General NPI Number Information
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NPI Number | 1396053682
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE CLINIC PC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 12/24/2012
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Provider Practice Location Address
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Address Line | 25614 FORD RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3024
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Country | US
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Telephone | 313-791-8000
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Fax | 313-791-8002
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Provider Business Mailing Address
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Address Line | 25614 FORD RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3024
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Country | US
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Telephone | 313-791-8000
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Fax | 313-791-8002
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Authorized Official
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Title or Position | OWNER
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Name | DR. NIDAL JBOOR
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Credential | M.D
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Telephone | 313-791-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301082688
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License Number State | MI
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