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20820 Greenfield Rd Ste 100 Oak Park MI 48237-3051 | |
| (248) 967-4310 | |
| (248) 967-4301 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 20820 Greenfield Rd Ste 100, Oak Park, Michigan |
| Authorized Official Name and Position | Ammar Mehdi Khan (PRESIDENT) |
| Authorized Official Contact | 2489674310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
20820 Greenfield Rd Ste 100 Oak Park MI 48237-3051 Ph: (248) 967-4310 | 20820 Greenfield Rd Ste 100 Oak Park MI 48237-3051 Ph: (248) 967-4310 |
| NPI Number | 1811020035 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 12/02/2024 |
| Certification Date | 12/02/2024 |
| Medicare PECOS PAC ID | 8022039742 |
|---|---|
| Medicare Enrollment ID | O20051209000233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811020035 | NPI | - | NPPES |
| 20445 | Other | MI | BLUE CROSS BLUE SHIELD |
| Provider Name | Gena A Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942592167 PECOS PAC ID: 0143218057 Enrollment ID: I20040430001162 |
| 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 | Raymond Charles Edison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679782346 PECOS PAC ID: 6901955426 Enrollment ID: I20090512000513 |
| Provider Name | Eliezer A Gomez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124257381 PECOS PAC ID: 5890841902 Enrollment ID: I20090915000260 |
| Provider Name | Kastytis L Buitkus |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1881638625 PECOS PAC ID: 9931377918 Enrollment ID: I20110718000613 |
| Provider Name | Antonino Agosta |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396913497 PECOS PAC ID: 0345482030 Enrollment ID: I20130808000549 |
| Provider Name | Kelsey A Lamb |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1194130658 PECOS PAC ID: 0143525360 Enrollment ID: I20180913000847 |
| Provider Name | Jude Osagie Ukpebor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669227161 PECOS PAC ID: 7810432325 Enrollment ID: I20241121002332 |
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