| Great Lakes Medical Group Pc | |
|
19070 E 10 Mile Rd Eastpointe MI 48021-1449 | |
| (313) 418-9952 | |
| Not Available |
| Full Name | Great Lakes Medical Group Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19070 E 10 Mile Rd, Eastpointe, Michigan |
| Authorized Official Name and Position | Mohamad Rahbar (PRESIDENT) |
| Authorized Official Contact | 3134189952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Medical Group Pc 19070 E 10 Mile Rd Eastpointe MI 48021-1449 Ph: (313) 418-9952 | Great Lakes Medical Group Pc 19070 E 10 Mile Rd Eastpointe MI 48021-1449 Ph: (313) 418-9952 |
| NPI Number | 1053787853 |
|---|---|
| Provider Enumeration Date | 08/15/2015 |
| Last Update Date | 08/15/2015 |
| Medicare PECOS PAC ID | 1557679073 |
|---|---|
| Medicare Enrollment ID | O20151002001904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053787853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 5315012655 (Michigan) | Primary |
| Provider Name | Mohamad Said Rahbar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679567762 PECOS PAC ID: 2466414800 Enrollment ID: I20041028000805 |
| Provider Name | Suham Dara Salman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326360504 PECOS PAC ID: 8123153103 Enrollment ID: I20100316000461 |
| Provider Name | Tesfamariam O Metiku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427289339 PECOS PAC ID: 5092981936 Enrollment ID: I20111227000651 |
| Provider Name | Hiro Rahbar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093151540 PECOS PAC ID: 1759685894 Enrollment ID: I20161026001220 |
| Provider Name | April M Provenzino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386194066 PECOS PAC ID: 0446495477 Enrollment ID: I20170201000529 |
| Provider Name | Humaira Rizvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225447766 PECOS PAC ID: 8426342031 Enrollment ID: I20170615002682 |
| Provider Name | Stacy L Conn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780226613 PECOS PAC ID: 7911321518 Enrollment ID: I20201028002946 |
| Provider Name | Katarzyna Noelle Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235701798 PECOS PAC ID: 9931505005 Enrollment ID: I20210915001688 |
| Provider Name | Omar Mizher Saaed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700406154 PECOS PAC ID: 2062833114 Enrollment ID: I20230821003512 |
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