MEDICARE: SYNERGY MEDICINE, PC

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	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1962696831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY MEDICINE, PC

Provider Business Mailing Address
First Line	:	23337 WOODWARD AVE
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1362
Country	:	US
Telephone Number	:	248-545-4852
Fax Number	:

Provider Business Practice Location Address
First Line	:	23337 WOODWARD AVE
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1362
Country	:	US
Telephone Number	:	248-545-4852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NISHATH KHURSHID HAKIM
Credential	:	MD
Telephone Number	:	248-545-4852

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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