Provider Demographics
NPI:1285614776
Name:SITA MEDICAL CLINIC
Entity type:Organization
Organization Name:SITA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-284-3100
Mailing Address - Street 1:29900 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1569
Mailing Address - Country:US
Mailing Address - Phone:248-865-9137
Mailing Address - Fax:248-865-9083
Practice Address - Street 1:995 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3861
Practice Address - Country:US
Practice Address - Phone:734-284-3100
Practice Address - Fax:734-284-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVM046803207Q00000X
MIDD032902207R00000X
MIME063139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty