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General NPI Number Information
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NPI Number | 1427962679
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE AND PAIN CLINIC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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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 | 313-354-3544
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAREK HADLA
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Credential |
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Telephone | 313-354-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State | NULL
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