Provider Demographics
NPI:1912120338
Name:WARRENFIELD MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:WARRENFIELD MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERFAN
Authorized Official - Middle Name:ADEL
Authorized Official - Last Name:OBEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-584-0018
Mailing Address - Street 1:14716 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1347
Mailing Address - Country:US
Mailing Address - Phone:313-584-0018
Mailing Address - Fax:313-581-9091
Practice Address - Street 1:14716 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1347
Practice Address - Country:US
Practice Address - Phone:313-584-0018
Practice Address - Fax:313-581-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700Q245380OtherBCBSM GROUP PIN
MI=========OtherTAX ID#
MI=========OtherTAX ID#