Provider Demographics
NPI:1891407524
Name:ADVANCE LASER THERAPY PLC
Entity Type:Organization
Organization Name:ADVANCE LASER THERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBASHIR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-331-9490
Mailing Address - Street 1:25591 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1306
Mailing Address - Country:US
Mailing Address - Phone:248-331-9490
Mailing Address - Fax:248-331-9254
Practice Address - Street 1:25591 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1306
Practice Address - Country:US
Practice Address - Phone:248-331-9490
Practice Address - Fax:248-331-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802956372OtherSTATE OF MICHIGAN LICENSING