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General NPI Number Information
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NPI Number | 1518211168
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Entity Type | Organization
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Legal Business Name | NORTH MEDICAL CLINIC P C
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 20041 W 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1438
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Country | US
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Telephone | 313-532-5030
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Fax | 313-532-0552
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Provider Business Mailing Address
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Address Line | 20041 W 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1438
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Country | US
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Telephone | 313-532-5030
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Fax | 313-532-0552
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANWAR ELKHATIB
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Credential | MD
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Telephone | 313-415-1989
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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 | 5601005669
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License Number State | MI
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