# INNOVATION MEDICINE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720511405
- **Authorized official:** BASEM ALMASRI M.D. (PHYSICIAN)
- **Authorized official phone:** (586) 772-2600

## Contact information

- **Practice address:** 25710 KELLY RD, STE 3, ROSEVILLE, MI 48066-4959
- **Practice address phone:** (586) 772-2600
- **Mailing address:** 25710 KELLY RD, STE 3, ROSEVILLE, MI 48066-4959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 04/10/2017
- **Last updated:** 12/12/2023