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General NPI Number Information
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NPI Number | 1568889251
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Entity Type | Organization
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Legal Business Name | INDEPENDENT MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 24825 MICHIGAN AVE STE B
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City | DEARBORN
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State | MI
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Zip | 48124-1758
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Country | US
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Telephone | 313-565-3365
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Fax | 313-565-3440
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Provider Business Mailing Address
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Address Line | 24825 MICHIGAN AVE STE B
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City | DEARBORN
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State | MI
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Zip | 48124-1758
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Country | US
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Telephone | 313-565-3365
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Fax | 313-565-3440
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Authorized Official
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Title or Position | LEADER
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Name | DR. ALI KADDOURA
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Credential | M.D
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Telephone | 313-565-3365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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