| Acadian Supreme Health Services | |
|
12866 Fort St Southgate MI 48195-1060 | |
| (313) 930-0258 | |
| Not Available |
| Full Name | Acadian Supreme Health Services |
|---|---|
| Speciality | Family Medicine |
| Location | 12866 Fort St, Southgate, Michigan |
| Authorized Official Name and Position | Ingrid N. Lewis (AUTHORIZED OFFICIAL/FNP) |
| Authorized Official Contact | 3139300258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Acadian Supreme Health Services 20831 Ridgemont Rd Harper Woods MI 48225-1137 Ph: (313) 930-0258 | Acadian Supreme Health Services 12866 Fort St Southgate MI 48195-1060 Ph: (313) 930-0258 |
| NPI Number | 1871108217 |
|---|---|
| Provider Enumeration Date | 09/12/2020 |
| Last Update Date | 09/12/2020 |
| Medicare PECOS PAC ID | 3678987252 |
|---|---|
| Medicare Enrollment ID | O20210121001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871108217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Eqdam Radhi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710155718 PECOS PAC ID: 1254485840 Enrollment ID: I20140819000473 |
| Provider Name | Ingrid Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639660046 PECOS PAC ID: 2769732932 Enrollment ID: I20180910001156 |
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