Provider Demographics
NPI:1992527493
Name:ALLEN PARK MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:ALLEN PARK MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-509-5999
Mailing Address - Street 1:7105 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2009
Mailing Address - Country:US
Mailing Address - Phone:313-509-5999
Mailing Address - Fax:313-509-6500
Practice Address - Street 1:7105 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2009
Practice Address - Country:US
Practice Address - Phone:313-509-5999
Practice Address - Fax:313-509-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center