Provider Demographics
NPI:1609811918
Name:SPORTS MEDICINE ASSOCIATES, PLC
Entity Type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIFAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-952-9200
Mailing Address - Street 1:37000 WOODWARD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0922
Mailing Address - Country:US
Mailing Address - Phone:248-952-9200
Mailing Address - Fax:248-952-9201
Practice Address - Street 1:37000 WOODWARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0922
Practice Address - Country:US
Practice Address - Phone:248-952-9200
Practice Address - Fax:248-952-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISR056808207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI698099OtherPHCS
MI131746OtherPREFERRED CHOICES, MOELLE
MIP105321OtherBLUE CARE NETWORK, MOELLE
MI109591OtherPREFERRED CHOICES, RIFAT
MI080F316700OtherBCBS
MIP85088OtherBLUE CARE NETWORK, RIFAT
MI109591OtherPREFERRED CHOICES, RIFAT
MIF68136Medicare UPIN
MIP105321OtherBLUE CARE NETWORK, MOELLE