Provider Demographics
NPI:1558588772
Name:SACRED HEART MEDICAL CENTRE PC
Entity Type:Organization
Organization Name:SACRED HEART MEDICAL CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-818-9193
Mailing Address - Street 1:9912 E GRAND RIVER AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1973
Mailing Address - Country:US
Mailing Address - Phone:810-588-4214
Mailing Address - Fax:810-588-4353
Practice Address - Street 1:9912 E GRAND RIVER AVE STE 1000
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1973
Practice Address - Country:US
Practice Address - Phone:810-588-4214
Practice Address - Fax:810-588-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0822017OtherSTEPHEN BISHOP BCN
MI456145010Medicaid
MI080H215880OtherGROUP ID BCBS
MI456144010Medicaid
MI0825550OtherJEFFREY P BERGER BCN
MI0822017OtherSTEPHEN BISHOP BCN
MI080H215880OtherGROUP ID BCBS
MI0825550OtherJEFFREY P BERGER BCN
MI456144010Medicaid