Provider Demographics
NPI:1275786493
Name:PACIFIC INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:PACIFIC INVESTMENT GROUP LLC
Other - Org Name:PRIMARY CHOICE PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOURRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-410-6003
Mailing Address - Street 1:27144 JOY RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2368
Mailing Address - Country:US
Mailing Address - Phone:313-410-6003
Mailing Address - Fax:313-937-1400
Practice Address - Street 1:27144 JOY RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2368
Practice Address - Country:US
Practice Address - Phone:313-410-6003
Practice Address - Fax:313-638-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care