Provider Demographics
NPI:1255164984
Name:ST MARY MEDICAL CENTER
Entity type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-965-3243
Mailing Address - Street 1:28091 DEQUINDRE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3071
Mailing Address - Country:US
Mailing Address - Phone:248-965-3243
Mailing Address - Fax:
Practice Address - Street 1:28091 DEQUINDRE RD STE 203
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3071
Practice Address - Country:US
Practice Address - Phone:248-965-3243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty