Organization
AMERICAN INDIAN HEALTH AND FAMILY SERVICES OF SOUTHEASTERN MI INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANETA ASSAF (DIRECTOR OF FINANCE)
(313) 846-3718
Entity
Organization
Contact information
Practice address
4880 LAWNDALESTREET, DETROIT, MI 48210
(313) 846-3718
(313) 846-0150
Mailing address
PO BOX 810, DEARBORN, MI 48121
(313) 846-3718
(313) 846-0150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H21011
BCBSM PIN/FACILITY CODE
MI
Enumeration date
08/30/2006
Last updated
04/21/2023
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