Organization
MY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA EL MASRI (CREDENTIALING COORDINATOR)
(248) 215-0048
Entity
Organization
Contact information
Practice address
4025 MAPLE ST STE B, DEARBORN, MI 48126-3532
(313) 269-4184
Mailing address
4025 MAPLE ST STE B, DEARBORN, MI 48126-3532
(313) 269-4184
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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