Provider Demographics
NPI:1366505802
Name:SPORTS MEDICINE ASSOCIATES,PLC
Entity type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIFAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-373-7286
Mailing Address - Street 1:3121 UNIVERSITY DR
Mailing Address - Street 2:STE 140
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2385
Mailing Address - Country:US
Mailing Address - Phone:248-373-7286
Mailing Address - Fax:248-475-5979
Practice Address - Street 1:3121 UNIVERSITY DR
Practice Address - Street 2:STE 140
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2385
Practice Address - Country:US
Practice Address - Phone:248-373-7286
Practice Address - Fax:248-475-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION12610Medicare ID - Type Unspecified
MIF56260Medicare UPIN
MIF68136Medicare UPIN