Provider Demographics
NPI:1083119705
Name:ACADIAN CLINIC PLLC
Entity Type:Organization
Organization Name:ACADIAN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-931-5713
Mailing Address - Street 1:30700 TELEGRAPH RD STE 1536
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4590
Mailing Address - Country:US
Mailing Address - Phone:248-215-0048
Mailing Address - Fax:
Practice Address - Street 1:14726 CHAMPAIGN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101
Practice Address - Country:US
Practice Address - Phone:313-789-7966
Practice Address - Fax:313-789-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty