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General NPI Number Information
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NPI Number | 1487231833
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Entity Type | Organization
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Legal Business Name | ICARE MEDICAL CLINIC PC
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 27209 LAHSER RD STE 225
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8401
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Country | US
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Telephone | 248-450-3493
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Fax | 248-450-3495
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Provider Business Mailing Address
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Address Line | 5250 KELLEN LN
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2738
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Country | US
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Telephone | 313-415-8684
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Fax | 248-450-3495
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SIHAM KIWAN
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Credential |
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Telephone | 313-415-8684
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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 |
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License Number State |
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