Provider Demographics
NPI:1295096345
Name:HOPE PRIMARY CARE ROMULUS
Entity type:Organization
Organization Name:HOPE PRIMARY CARE ROMULUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-412-5590
Mailing Address - Street 1:9340 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1569
Mailing Address - Country:US
Mailing Address - Phone:810-412-5590
Mailing Address - Fax:810-412-5593
Practice Address - Street 1:9171 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3617
Practice Address - Country:US
Practice Address - Phone:810-412-5590
Practice Address - Fax:810-412-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056997173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty