Provider Demographics
NPI:1144237082
Name:ENDOCRINE & DIABETES CONSULTANTS PC
Entity Type:Organization
Organization Name:ENDOCRINE & DIABETES CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULSALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-844-1873
Mailing Address - Street 1:2970 CROOKS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3609
Mailing Address - Country:US
Mailing Address - Phone:248-844-1873
Mailing Address - Fax:248-844-0219
Practice Address - Street 1:2970 CROOKS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3609
Practice Address - Country:US
Practice Address - Phone:248-844-1873
Practice Address - Fax:248-844-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062353207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F325740OtherBCBSM
MI110F325740OtherBCBSM
MI=========Medicaid
0P10440Medicare ID - Type Unspecified
MI110F325740OtherBCBSM