Provider Demographics
NPI:1295813129
Name:PULSAR MEDICAL GROUP PC
Entity type:Organization
Organization Name:PULSAR MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-532-8500
Mailing Address - Street 1:35110 GLENGARY CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2618
Mailing Address - Country:US
Mailing Address - Phone:313-966-3565
Mailing Address - Fax:810-765-8169
Practice Address - Street 1:538 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1605
Practice Address - Country:US
Practice Address - Phone:810-765-8104
Practice Address - Fax:810-765-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS044111207R00000X
MIMK059699207R00000X
MIWH055371207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION76740Medicare ID - Type UnspecifiedMEDICARE GROUP