| Institute Of Supportive Services, Inc. | |
|
19940 Conant St Ste Abc Detroit MI 48234-1494 | |
| (313) 733-4528 | |
| (313) 733-4532 |
| Full Name | Institute Of Supportive Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 19940 Conant St Ste Abc, Detroit, Michigan |
| Authorized Official Name and Position | Marvin Arnold (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3137334528 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Institute Of Supportive Services, Inc. 19940 Conant St Ste Abc Detroit MI 48234-1494 Ph: (313) 733-4528 | Institute Of Supportive Services, Inc. 19940 Conant St Ste Abc Detroit MI 48234-1494 Ph: (313) 733-4528 |
| NPI Number | 1346613403 |
|---|---|
| Provider Enumeration Date | 11/10/2015 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 0840565388 |
|---|---|
| Medicare Enrollment ID | O20171009002482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346613403 | NPI | - | NPPES |
| Provider Name | Zakari M Tata |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871591313 PECOS PAC ID: 9436049806 Enrollment ID: I20040318001713 |
| Provider Name | Marcella Clark |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1902028913 PECOS PAC ID: 9234236431 Enrollment ID: I20070523000335 |
| Provider Name | Andrew J Ruden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881717049 PECOS PAC ID: 7416048012 Enrollment ID: I20070810000785 |
| Provider Name | Angela L Roman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235196023 PECOS PAC ID: 5193817773 Enrollment ID: I20070828000270 |
| Provider Name | Khawar A Chaudhry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538422548 PECOS PAC ID: 9537390836 Enrollment ID: I20150618002343 |
| Provider Name | Jennifer Rose Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740568377 PECOS PAC ID: 4284937756 Enrollment ID: I20160119000187 |
| Provider Name | Constance L Durden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538668595 PECOS PAC ID: 8426318569 Enrollment ID: I20180209000074 |
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