Organization
MICHIGAN SPECIALTY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FATINA MASRI M.D. (OWNER)
(313) 945-9188
Entity
Organization
Contact information
Practice address
13530 MICHIGAN AVE, SUITE 120, DEARBORN, MI 48126-3583
(313) 945-9188
(313) 945-9184
Mailing address
13530 MICHIGAN AVE STE 400, DEARBORN, MI 48126-3575
(313) 945-9188
(313) 945-9184
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
207Y00000X
Otolaryngology Physician
4301052487
MI
207YS0012X
Sleep Medicine (Otolaryngology) Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
4301052487
MI
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208200000X
Plastic Surgery Physician
4301052487
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
4301052487
MI
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760800660
—
MI
01
—
700H269700
BCBS GROUP
MI
01
—
700H269700
BCN GROUP
—
01
—
DS8165
RAILROAD MEDICARE
MI
Enumeration date
05/17/2010
Last updated
03/10/2020
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