Provider Demographics
NPI:1477109528
Name:PREMIER MEDICAL MOVEMENT MANAGEMENT COMPANY LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL MOVEMENT MANAGEMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOUEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-207-5767
Mailing Address - Street 1:529 N GULLEY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3453
Mailing Address - Country:US
Mailing Address - Phone:313-207-5767
Mailing Address - Fax:
Practice Address - Street 1:26000 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1167
Practice Address - Country:US
Practice Address - Phone:586-434-5260
Practice Address - Fax:586-434-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty