Executive Plaza Medical, P.C.
Multi-Specialty Clinic/Center in Dearborn, MI(View on Map)
Legal Business Name
Executive Plaza Medical, P.C.
NPI Number
1952715153
NPI Type
Organization
Enumeration Date
06/16/2014
Specialties
(Taxonomies)Code
261QM1300X
208D00000X
Primary Taxonomy
Yes
No
Licenses
State
Michigan
Michigan
Michigan
License Number
5101006652
4301405559
4301405324
Contact
Information
Purpose
Mailing
Location
Address
17000 EXECUTIVE PLAZA DR
17000 EXECUTIVE PLAZA DR
City
Dearborn
Dearborn
State
MI
MI
Postal Code
48126-2793
48126-2793
Country
US
US
Telephone Number
(313) 915-4632
(313) 915-4632
Authorized Official
Name
Hossam Hossein
Title or Position
MANAGER
Telephone Number
(313) 915-4632
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 01/13/2015
Provider Address
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