Provider Demographics
NPI:1487231833
Name:ICARE MEDICAL CLINIC PC
Entity type:Organization
Organization Name:ICARE MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SIHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-415-8684
Mailing Address - Street 1:5250 KELLEN LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2738
Mailing Address - Country:US
Mailing Address - Phone:313-415-8684
Mailing Address - Fax:248-450-3495
Practice Address - Street 1:27209 LAHSER RD STE 225
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8401
Practice Address - Country:US
Practice Address - Phone:248-450-3493
Practice Address - Fax:248-450-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty