Provider Demographics
NPI:1477940294
Name:ADVANCE PRIMARY CARE
Entity Type:Organization
Organization Name:ADVANCE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEINALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-485-4513
Mailing Address - Street 1:1000 E STADIUM BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4616
Mailing Address - Country:US
Mailing Address - Phone:734-769-3333
Mailing Address - Fax:
Practice Address - Street 1:1000 E STADIUM BLVD STE E
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4616
Practice Address - Country:US
Practice Address - Phone:734-769-3333
Practice Address - Fax:734-769-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty