Provider Demographics
NPI:1629021068
Name:ROCHESTER HILLS AMBULATORY CARE CENTER PLLC
Entity Type:Organization
Organization Name:ROCHESTER HILLS AMBULATORY CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KASMIKHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-652-1365
Mailing Address - Street 1:1498 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1739
Mailing Address - Country:US
Mailing Address - Phone:248-652-1365
Mailing Address - Fax:248-652-1042
Practice Address - Street 1:1498 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1739
Practice Address - Country:US
Practice Address - Phone:248-652-1365
Practice Address - Fax:248-652-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N56320Medicare ID - Type Unspecified