| My Clinic Pllc | |
|
4025 Maple St Ste B Dearborn MI 48126-3532 | |
| (313) 269-4184 | |
| Not Available |
| Full Name | My Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4025 Maple St Ste B, 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 |
|---|---|
| My Clinic Pllc 4025 Maple St Ste B Dearborn MI 48126-3532 Ph: (313) 269-4184 | My Clinic Pllc 4025 Maple St Ste B Dearborn MI 48126-3532 Ph: (313) 269-4184 |
| NPI Number | 1689216699 |
|---|---|
| Provider Enumeration Date | 10/10/2019 |
| Last Update Date | 10/10/2019 |
| Medicare PECOS PAC ID | 4486087111 |
|---|---|
| Medicare Enrollment ID | O20191210002207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689216699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Hassan Abou-rass |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831596428 PECOS PAC ID: 5991028169 Enrollment ID: I20141218001443 |
| Provider Name | Shukri Y Ashaweh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750944633 PECOS PAC ID: 9830426592 Enrollment ID: I20190805000615 |
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