Executive Medical Center PLLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

EXECUTIVE MEDICAL CENTER PLLC

Practice address

17000 Executive Plaza Dr Ste 104
Dearborn, MI 48126-2793

Phone

(313) 879-0111

Fax

(313) 879-0222

NPI assigned

Apr 17, 2023

Organization subpart

No

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

Authorized official

Name

Hassan Dakroub, MDNPI 1528099397

Title

Owner

Phone

(313) 485-0111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hassan N Dakroub, M.D.

  • Infectious Disease Physician
  • Dearborn, MI
  • NPI 1528099397
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1316633860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR STE 104",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-879-0111",
            "fax_number": "313-879-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR STE 104",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-879-0111",
            "fax_number": "313-879-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-10-03",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "DAKROUB",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-485-0111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Infectious Disease Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.