Provider Demographics
NPI:1780348086
Name:A3 PRIMARY CARE
Entity type:Organization
Organization Name:A3 PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-215-0048
Mailing Address - Street 1:4050 W MAPLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3148
Mailing Address - Country:US
Mailing Address - Phone:248-885-8211
Mailing Address - Fax:
Practice Address - Street 1:4050 W MAPLE RD STE B
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3148
Practice Address - Country:US
Practice Address - Phone:248-885-8211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty