| Family Doc Clinic And Urgent Care Pllc | |
|
25350 W Warren St Dearborn Heights MI 48127-2102 | |
| (313) 914-3666 | |
| (313) 380-0672 |
| Full Name | Family Doc Clinic And Urgent Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 25350 W Warren St, Dearborn Heights, Michigan |
| Authorized Official Name and Position | Ali Ibrahim Nasrallah (PRESIDENT) |
| Authorized Official Contact | 3139143666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Doc Clinic And Urgent Care Pllc 25350 W Warren St Dearborn Heights MI 48127-2102 Ph: (313) 914-3666 | Family Doc Clinic And Urgent Care Pllc 25350 W Warren St Dearborn Heights MI 48127-2102 Ph: (313) 914-3666 |
| NPI Number | 1104406289 |
|---|---|
| Provider Enumeration Date | 04/12/2021 |
| Last Update Date | 12/05/2022 |
| Medicare PECOS PAC ID | 4688078249 |
|---|---|
| Medicare Enrollment ID | O20210804003533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104406289 | NPI | - | NPPES |
| 4301503083 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Shireen Fradi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730553819 PECOS PAC ID: 8325344617 Enrollment ID: I20160314000440 |
| Provider Name | Ahmed Mirza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407320559 PECOS PAC ID: 0840530341 Enrollment ID: I20200716002927 |
| Provider Name | Miriam Amen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275143273 PECOS PAC ID: 7315351558 Enrollment ID: I20210128002011 |
| Provider Name | Ali Ibrahim Nasrallah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972096261 PECOS PAC ID: 7214285550 Enrollment ID: I20210426001205 |
| Provider Name | Zainab Elizabeth Saad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437883253 PECOS PAC ID: 0244616555 Enrollment ID: I20221010001569 |
| Provider Name | Joseph R Mazur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194592394 PECOS PAC ID: 0749629368 Enrollment ID: I20240416001699 |
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