Provider Demographics
NPI:1225613870
Name:PULSE PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:PULSE PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ABLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-207-5767
Mailing Address - Street 1:15400 MICHIGAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3491
Mailing Address - Country:US
Mailing Address - Phone:313-584-3359
Mailing Address - Fax:313-584-1729
Practice Address - Street 1:15400 MICHIGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3491
Practice Address - Country:US
Practice Address - Phone:313-207-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty