Provider Demographics
NPI:1033389606
Name:GREENFIELD MEDICAL CENTER OF DEARBORN, P.C.
Entity Type:Organization
Organization Name:GREENFIELD MEDICAL CENTER OF DEARBORN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-2121
Mailing Address - Street 1:5479 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3222
Mailing Address - Country:US
Mailing Address - Phone:313-581-2121
Mailing Address - Fax:313-581-9206
Practice Address - Street 1:5479 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3222
Practice Address - Country:US
Practice Address - Phone:313-581-2121
Practice Address - Fax:313-581-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062443261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care