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General NPI Number Information
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NPI Number | 1528445632
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Entity Type | Organization
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Legal Business Name | EXECUTIVE HEALTH PC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 1213 MASON ST
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City | DEARBORN
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State | MI
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Zip | 48124-2841
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Country | US
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Telephone | 313-278-2800
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Fax | 313-278-0030
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Provider Business Mailing Address
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Address Line | 1213 MASON ST
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City | DEARBORN
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State | MI
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Zip | 48124-2841
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Country | US
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Telephone | 313-278-2800
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Fax | 313-278-0030
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Authorized Official
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Title or Position | PRESEDENT
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Name | MASSUD ALMASSUDI
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Credential | MD
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Telephone | 313-278-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology 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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 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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