| Life Medical Center | |
|
25325 Ford Rd Ste 200 Dearborn MI 48128-1086 | |
| (313) 456-5050 | |
| (313) 914-5922 |
| Full Name | Life Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 25325 Ford Rd Ste 200, Dearborn, Michigan |
| Authorized Official Name and Position | Diana El Masri (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2482150048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Medical Center 30700 Telegraph Rd Ste 3670 Bingham Farms MI 48025-4568 Ph: () - | Life Medical Center 25325 Ford Rd Ste 200 Dearborn MI 48128-1086 Ph: (313) 456-5050 |
| NPI Number | 1366077000 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 04/10/2023 |
| Medicare PECOS PAC ID | 9032549506 |
|---|---|
| Medicare Enrollment ID | O20200423003060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366077000 | NPI | - | NPPES |
| PENDING | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohamed A Eldirani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801139928 PECOS PAC ID: 4486886967 Enrollment ID: I20160727001828 |
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