Provider Demographics
NPI:1376929562
Name:MICHIGAN HOME PHYSICIAN SERVICE, PLLC
Entity Type:Organization
Organization Name:MICHIGAN HOME PHYSICIAN SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-797-5293
Mailing Address - Street 1:26645 W 12 MILE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7811
Mailing Address - Country:US
Mailing Address - Phone:248-797-5293
Mailing Address - Fax:248-440-5351
Practice Address - Street 1:26645 W 12 MILE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7811
Practice Address - Country:US
Practice Address - Phone:248-797-5293
Practice Address - Fax:248-440-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty