Individual provider Active NPI

Malak Elsabbagh, NP-C

  • Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1003614348
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704317480 Issued in MI
Practice address
4700 Greenfield Rd Ste 2E
Dearborn, MI 48126-4124
Phone
(313) 740-1111
NPI assigned
Mar 4, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704317480 MI Primary

Addresses

Primary practice location

4700 Greenfield Rd Ste 2E
Dearborn, MI 48126-4124

Mailing address

4700 Greenfield Rd Ste 2E
Dearborn, MI 48126-4124
Phone (313) 740-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250630003574 MI Practitioner - Nurse Practitioner 2567975832 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providers Tek IncGroup PAC ID 2264792084, 13 clinicians

Practice addresses (Care Compare)

4700 Greenfield Rd
Suite 2E
Dearborn, MI 48126-4124
Phone (313) 740-1111

Hospital & facility affiliations

  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704317480MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverview Neuromuscular Pain Center PLLC CurrentSince May 15, 2025 Accepting new patients
Providers Tek Inc. CurrentSince May 15, 2025 Accepting new patients

Locations

4700 Greenfield Rd
Ste 2E
Dearborn, MI 48126
Phone (313) 740-1111

7633 E Jefferson Ave
Ste 170
Detroit, MI 48214
Phone (313) 401-0256

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1003614348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 GREENFIELD RD STE 2E",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264124",
            "telephone_number": "313-740-1111",
            "fax_number": "313-672-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 GREENFIELD RD STE 2E",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264124",
            "telephone_number": "313-740-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELSABBAGH",
        "first_name": "MALAK",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-04",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704317480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.