Provider Demographics
NPI:1598279804
Name:GREENFIELD AND 9 MILE MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:GREENFIELD AND 9 MILE MEDICAL CENTER PLLC
Other - Org Name:AMERICAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJM-UL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-3303
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:STE 607M
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5355
Mailing Address - Country:US
Mailing Address - Phone:248-557-3303
Mailing Address - Fax:586-722-2722
Practice Address - Street 1:20905 GREENFIELD RD STE 607M
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5355
Practice Address - Country:US
Practice Address - Phone:248-557-3303
Practice Address - Fax:586-722-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265874945Medicaid