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NPI Code Detail

MEDICARE: SUMAIYA ISLAM

MEDICARE: SUMAIYA ISLAM
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
1207Q00000XFamily Medicine Physician4301108155MI

General Provider Information

NPI Number : 1790168557
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMAIYA ISLAM
Provider Business Mailing Address
First Line : 1350 W BETHUNE ST
Second Line : 1205
City : DETROIT
State : MI
Zip : 48202-2600
Country : US
Telephone Number : 313-335-6195
Fax Number :
Provider Business Practice Location Address
First Line : 3370 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-4236
Country : US
Telephone Number : 313-656-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2015
Last Update Date : 06/29/2015

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Directions to “ SUMAIYA ISLAM ” Practice Location

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