Provider Demographics
NPI:1033154216
Name:MICHIGAN MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:MICHIGAN MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-265-4080
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-0150
Mailing Address - Country:US
Mailing Address - Phone:248-265-4080
Mailing Address - Fax:248-265-4082
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-945-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H231730OtherBCBS
MIE77778OtherHAP
MI10486243Medicaid
MI029575OtherMIDWEST HEALTH PLAN
MI7761OtherTOTAL HEALTH CARE
MIC7669OtherMCARE
MIDE7851OtherRAILROAD MEDICARE
MI131038OtherCARE CHOICES
MIE77778OtherHAP
E77778Medicare UPIN