| Executive Health Pc | |
|
1213 Mason St Dearborn MI 48124-2841 | |
| (313) 278-2800 | |
| (313) 278-0030 |
| Full Name | Executive Health Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1213 Mason St, Dearborn, Michigan |
| Authorized Official Name and Position | Massud Almassudi (PRESEDENT) |
| Authorized Official Contact | 3132782800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Executive Health Pc 1213 Mason St Dearborn MI 48124-2841 Ph: (313) 278-2800 | Executive Health Pc 1213 Mason St Dearborn MI 48124-2841 Ph: (313) 278-2800 |
| NPI Number | 1528445632 |
|---|---|
| Provider Enumeration Date | 04/28/2015 |
| Last Update Date | 09/21/2015 |
| Medicare PECOS PAC ID | 1456672088 |
|---|---|
| Medicare Enrollment ID | O20150608000906 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528445632 | NPI | - | NPPES |
| Provider Name | Mustapha M Mallah |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1104879683 PECOS PAC ID: 1850285875 Enrollment ID: I20040211000323 |
| Provider Name | Shehnaz Rizvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619957420 PECOS PAC ID: 0446228308 Enrollment ID: I20040920000565 |
| Provider Name | Sadiq H Rizvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538149828 PECOS PAC ID: 2769450618 Enrollment ID: I20040920000588 |
| Provider Name | Mary P Lange |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740394055 PECOS PAC ID: 7618074139 Enrollment ID: I20070517000625 |
| Provider Name | Massud T Almassudi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700140431 PECOS PAC ID: 7012238678 Enrollment ID: I20150608002570 |
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