Provider Demographics
NPI:1427232057
Name:PROFESSIONAL HEALTH CARE PROVIDERS
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FADLALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:313-610-6659
Mailing Address - Street 1:2011 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2819
Mailing Address - Country:US
Mailing Address - Phone:313-610-6659
Mailing Address - Fax:734-367-1214
Practice Address - Street 1:2011 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2819
Practice Address - Country:US
Practice Address - Phone:313-610-6659
Practice Address - Fax:734-367-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty