Provider Demographics
NPI:1184847808
Name:HAMTRAMCK COMMUNITY MEDICAL CENTER PC
Entity Type:Organization
Organization Name:HAMTRAMCK COMMUNITY MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REDWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-851-1430
Mailing Address - Street 1:2835 TUMBLEWEED DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7021
Mailing Address - Country:US
Mailing Address - Phone:313-556-9900
Mailing Address - Fax:
Practice Address - Street 1:9740 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3307
Practice Address - Country:US
Practice Address - Phone:313-556-9900
Practice Address - Fax:313-556-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H217400OtherBLUE CROSS
700H217400OtherBLUE CROSS