Provider Demographics
NPI:1306161781
Name:PACCSA, L.L.C.
Entity type:Organization
Organization Name:PACCSA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-207-1247
Mailing Address - Street 1:950 W AVON RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2761
Mailing Address - Country:US
Mailing Address - Phone:248-651-6430
Mailing Address - Fax:248-650-1382
Practice Address - Street 1:57850 VAN DYKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3826
Practice Address - Country:US
Practice Address - Phone:586-207-1247
Practice Address - Fax:586-207-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty