Provider Demographics
NPI:1780988501
Name:NATURAL HEALTH CLINI OF GROSSE POINT
Entity type:Organization
Organization Name:NATURAL HEALTH CLINI OF GROSSE POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMFIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-944-2064
Mailing Address - Street 1:30301 WOODWARD AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24025 GREATER MACK AVE
Practice Address - Street 2:STE 204
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1484
Practice Address - Country:US
Practice Address - Phone:586-944-2064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301025718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0502622Medicare PIN