| Vitality Health Clinic Pllc | |
|
4245 S Beech Daly St Ste 102 Dearborn Heights MI 48125-1576 | |
| (313) 414-0703 | |
| Not Available |
| Full Name | Vitality Health Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4245 S Beech Daly St Ste 102, Dearborn Heights, Michigan |
| Authorized Official Name and Position | Rawya Kazan (NURSE PRACTITIONER) |
| Authorized Official Contact | 3134140703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Health Clinic Pllc 4245 S Beech Daly St Dearborn Heights MI 48125-1576 Ph: (313) 414-0703 | Vitality Health Clinic Pllc 4245 S Beech Daly St Ste 102 Dearborn Heights MI 48125-1576 Ph: (313) 414-0703 |
| NPI Number | 1689430407 |
|---|---|
| Provider Enumeration Date | 02/28/2024 |
| Last Update Date | 04/18/2024 |
| Medicare PECOS PAC ID | 7911345103 |
|---|---|
| Medicare Enrollment ID | O20240408000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689430407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Mohamed Ayad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417924309 PECOS PAC ID: 4082502661 Enrollment ID: I20040305000658 |
| Provider Name | Mariam A Abbas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982352811 PECOS PAC ID: 3577717347 Enrollment ID: I20220518000648 |
| Provider Name | Rawya Kazan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023743432 PECOS PAC ID: 4284018730 Enrollment ID: I20220831003794 |
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