| Michigan Sports Medicine Pc | |
|
23902 Ford Rd Suite A Dearborn Heights MI 48127-3246 | |
| (313) 562-4700 | |
| (313) 562-4701 |
| Full Name | Michigan Sports Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 23902 Ford Rd, Dearborn Heights, Michigan |
| Authorized Official Name and Position | Tarek Hadla (MD) |
| Authorized Official Contact | 3135624700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Sports Medicine Pc 23902 Ford Rd Suite A Dearborn Heights MI 48127-3246 Ph: (313) 562-4700 | Michigan Sports Medicine Pc 23902 Ford Rd Suite A Dearborn Heights MI 48127-3246 Ph: (313) 562-4700 |
| NPI Number | 1326481623 |
|---|---|
| Provider Enumeration Date | 04/17/2013 |
| Last Update Date | 05/15/2015 |
| Medicare PECOS PAC ID | 9335373190 |
|---|---|
| Medicare Enrollment ID | O20131009001925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326481623 | NPI | - | NPPES |
| 0H28306 | Other | MI | BCBS GRP |
| DU1788 | Other | MI | RAILROAD MEDICARE |
| 0H28306 | Other | MI | BCN GRP |
| 1326481623 | Medicaid | MI | |
| 6986550001 | Other | MI | MEDICARE DME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 4301065806 (Michigan) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 4301095806 (Michigan) | Secondary |
| Provider Name | Tarek Hadla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568636629 PECOS PAC ID: 3375694698 Enrollment ID: I20101021000449 |
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