Provider Demographics
NPI:1386956027
Name:DELTA SOUL MEDICAL, LLC
Entity type:Organization
Organization Name:DELTA SOUL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEYAD
Authorized Official - Middle Name:KAMEL
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-830-4662
Mailing Address - Street 1:311 N BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0401
Mailing Address - Country:US
Mailing Address - Phone:248-830-4662
Mailing Address - Fax:248-322-9972
Practice Address - Street 1:102 N. PEARMAN AVE.
Practice Address - Street 2:STE. 1
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732
Practice Address - Country:US
Practice Address - Phone:662-843-0006
Practice Address - Fax:662-843-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based