Provider Demographics
NPI:1285660571
Name:SENIOR CARE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:SENIOR CARE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-945-5450
Mailing Address - Street 1:15400 MICHIGAN AVE
Mailing Address - Street 2:STE (1)
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-584-3359
Mailing Address - Fax:313-584-1729
Practice Address - Street 1:15400 MICHIGAN AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3491
Practice Address - Country:US
Practice Address - Phone:313-584-3359
Practice Address - Fax:313-584-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBA059825207R00000X
MIKM171632364SL0600X
MIMZ112158364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4933009Medicaid
MIG16950Medicare UPIN