Provider Demographics
NPI:1336665728
Name:PELHAM PRIMARY CARE PC
Entity Type:Organization
Organization Name:PELHAM PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RIBHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-789-7636
Mailing Address - Street 1:3815 PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3852
Mailing Address - Country:US
Mailing Address - Phone:313-789-7636
Mailing Address - Fax:313-789-7018
Practice Address - Street 1:3815 PELHAM ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-789-7636
Practice Address - Fax:313-789-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty