Provider Demographics
NPI:1295247633
Name:MICHIGAN SPECIALTY CLINIC PLLC
Entity type:Organization
Organization Name:MICHIGAN SPECIALTY CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-945-9800
Mailing Address - Street 1:PO BOX 94670
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-4670
Mailing Address - Country:US
Mailing Address - Phone:405-682-3303
Mailing Address - Fax:304-384-6793
Practice Address - Street 1:13510 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3511
Practice Address - Country:US
Practice Address - Phone:313-945-9800
Practice Address - Fax:313-945-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty