Provider Demographics
NPI:1619463023
Name:REAL ESTATE 4000 LLC
Entity Type:Organization
Organization Name:REAL ESTATE 4000 LLC
Other - Org Name:SUMPTER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-377-5331
Mailing Address - Street 1:27055 NORTHMORE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3643
Mailing Address - Country:US
Mailing Address - Phone:313-377-5331
Mailing Address - Fax:
Practice Address - Street 1:19130 SUMPTER RD
Practice Address - Street 2:
Practice Address - City:SUMPTER TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-8724
Practice Address - Country:US
Practice Address - Phone:313-485-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REAL ESTATE 4000 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty