Organization
EXECUTIVE PLAZA MEDICAL, P.C.
Active
Organization
EXECUTIVE PLAZA MEDICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOSSAM A HOSSEIN (MANAGER)
(313) 915-4632
Entity
Organization
Contact information
Practice address
17000 EXECUTIVE PLAZA DR, SUITE 103, DEARBORN, MI 48126-2793
(313) 915-4632
(313) 915-4634
Mailing address
17000 EXECUTIVE PLAZA DR, SUITE 103, DEARBORN, MI 48126-2793
(313) 915-4632
(313) 915-4634
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
5101006652
MI
261QM1300X
Multi-Specialty Clinic/Center
4301405324
MI
261QM1300X
Multi-Specialty Clinic/Center
4301405559
MI
261QM1300X
Multi-Specialty Clinic/Center
Primary
5101006652
MI
Other
Enumeration date
06/16/2014
Last updated
01/13/2015
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