Provider Demographics
NPI:1558666891
Name:ISMAIL B SENDI MD, PC
Entity Type:Organization
Organization Name:ISMAIL B SENDI MD, PC
Other - Org Name:NEW OAKLAND CHILD ADOLESCENT AND FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SENDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-634-6303
Mailing Address - Street 1:12850 FOUNTAIN SQ
Mailing Address - Street 2:STE 106
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2552
Mailing Address - Country:US
Mailing Address - Phone:248-634-6303
Mailing Address - Fax:248-634-1746
Practice Address - Street 1:26522 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1221
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910681OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI018954OtherMIDWEST HEALTH PLAN
MI0910932OtherBLUE CARE NETWORK
MI5055OtherMACOMB COUNTY CMH
MIXX19153OtherHEALTHPLUS
MI0910932OtherBLUE CARE NETWORK