Provider Demographics
NPI:1396029161
Name:DETROIT CLINICAL RESEARCH CENTER, PC
Entity Type:Organization
Organization Name:DETROIT CLINICAL RESEARCH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHED
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MBA
Authorized Official - Phone:248-773-8979
Mailing Address - Street 1:27780 NOVI RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3401
Mailing Address - Country:US
Mailing Address - Phone:248-773-8979
Mailing Address - Fax:248-468-1155
Practice Address - Street 1:27780 NOVI RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3401
Practice Address - Country:US
Practice Address - Phone:248-773-8979
Practice Address - Fax:248-468-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02264X207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty