Provider Demographics
NPI:1861510968
Name:INTEGRATED HEALTH CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CARE ASSOCIATES PC
Other - Org Name:INTEGRATED HEALTH CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:MOKHAYESH
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-669-5050
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 2140
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-669-5050
Mailing Address - Fax:248-669-1700
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2140
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-669-5050
Practice Address - Fax:248-669-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081351207Q00000X
MI4301076848207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675192Medicaid
MI=========OtherEIN
MIN89750001Medicare ID - Type UnspecifiedSYED
MIN89750001Medicare PIN
MI4675192Medicaid
MI=========OtherEIN
MI0N89750Medicare PIN
MII17583Medicare UPIN
MIN89750002Medicare ID - Type UnspecifiedPARK-DAVIS
MIN89750003Medicare PIN