Provider Demographics
NPI:1013377027
Name:ALLEN PARK INTERNAL MEDICINE P.C.
Entity Type:Organization
Organization Name:ALLEN PARK INTERNAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-590-7705
Mailing Address - Street 1:14551 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2687
Mailing Address - Country:US
Mailing Address - Phone:313-388-0910
Mailing Address - Fax:313-388-6630
Practice Address - Street 1:14551 SOUTHFIELD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2687
Practice Address - Country:US
Practice Address - Phone:313-388-0910
Practice Address - Fax:313-388-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74045Medicare UPIN
MI08222341111Medicare PIN