Organization
MICHIGAN SPORTS MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK SALIM HADLA MD (PHYSICIAN/AUTH OFFICAL)
(313) 562-4700
Entity
Organization
Contact information
Practice address
23902 FORD RD STE A, DEARBORN HEIGHTS, MI 48127-3246
(313) 562-4700
(313) 562-4701
Mailing address
23902 FORD RD STE A, DEARBORN HEIGHTS, MI 48127-3246
(313) 562-4700
(313) 562-4701
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4301095806
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6986550001
NCS/DME
MI
Enumeration date
04/05/2018
Last updated
06/16/2018
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