MEDICARE: TOTAL MEDICAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	IH031344	MI

General Provider Information

NPI Number	:	1780997841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL MEDICAL CARE

Provider Business Mailing Address
First Line	:	3611 CARPENTER ST STE 7
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48212-2784
Country	:	US
Telephone Number	:	313-893-9881
Fax Number	:	313-893-9887

Provider Business Practice Location Address
First Line	:	3611 CARPENTER ST STE 7
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48212-2784
Country	:	US
Telephone Number	:	313-893-9881
Fax Number	:	313-893-9887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IHSAN HAQ
Credential	:	M.D.
Telephone Number	:	586-549-5428

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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