Provider Demographics
NPI:1417248139
Name:ADVANCE CARING PHYSICIANS LLP
Entity Type:Organization
Organization Name:ADVANCE CARING PHYSICIANS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-397-1907
Mailing Address - Street 1:PO BOX 871400
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-7300
Mailing Address - Country:US
Mailing Address - Phone:313-397-1907
Mailing Address - Fax:313-397-2125
Practice Address - Street 1:7612 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2822
Practice Address - Country:US
Practice Address - Phone:313-397-1907
Practice Address - Fax:313-397-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2284578Medicaid
MI034692OtherDMC
MI0H27415OtherBC
MIDS6002OtherRR
MIMI5247Medicare PIN