Provider Demographics
NPI:1437653532
Name:OSAMA ELSABAGH MD PLLC
Entity Type:Organization
Organization Name:OSAMA ELSABAGH MD PLLC
Other - Org Name:SUMMIT CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSABAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-992-9408
Mailing Address - Street 1:55 N POND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3080
Mailing Address - Country:US
Mailing Address - Phone:248-624-6633
Mailing Address - Fax:248-624-0748
Practice Address - Street 1:55 N POND DR STE 2
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3080
Practice Address - Country:US
Practice Address - Phone:248-624-6633
Practice Address - Fax:248-624-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty