Provider Demographics
NPI:1700245271
Name:SUMMIT TOTAL CARE PLLC
Entity Type:Organization
Organization Name:SUMMIT TOTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-844-0779
Mailing Address - Street 1:1935 N. PONTIAC TRL # A
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3110
Mailing Address - Country:US
Mailing Address - Phone:248-624-6633
Mailing Address - Fax:248-624-0748
Practice Address - Street 1:55 N POND DR STE 2
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3080
Practice Address - Country:US
Practice Address - Phone:248-624-6633
Practice Address - Fax:248-624-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102602207Q00000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI10238Medicare PIN