Michigan Sports Medicine PC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

4301065806 Issued in MI

Legal business name

MICHIGAN SPORTS MEDICINE PC

Practice address

23902 Ford Rd
Suite a
Dearborn Heights, MI 48127-3246

Phone

(313) 562-4700

Fax

(313) 562-4701

NPI assigned

Apr 17, 2013

Last updated

May 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tarek Hadla, MDNPI 1568636629

Title

MD

Phone

(313) 562-4700

Specialties & licenses 2

Addresses

Other identifiers 5

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, and the practitioner matching its NPPES authorized official.

• Tarek Salim Hadla, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Southfield, MI
  • NPI 1568636629
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1326481623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23902 FORD RD",
            "address_2": "SUITE A",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273246",
            "telephone_number": "313-562-4700",
            "fax_number": "313-562-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23902 FORD RD",
            "address_2": "SUITE A",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273246",
            "telephone_number": "313-562-4700",
            "fax_number": "313-562-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-17",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "HADLA",
        "authorized_official_first_name": "TAREK",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "313-562-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4301095806",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301065806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "6986550001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN GRP",
            "identifier": "0H28306",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326481623",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP",
            "identifier": "0H28306",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DU1788",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michigan Glaucoma Institute PC (yaldo eye center)
• Michigan Institute of Vascular and Interventional Radiology, PLLC (Mivir, PLLC)
• Michigan Primary Care Center PC
• Michigan Rehabilitation Center LLC
• Michigan Sleep Network, P.C.
• Michigan Sports Medicine PC
• Michigan Therapeutic Solutions, Inc.
• Midwest Compounding LLC
• Midwest Surgical Affiliates, PLLC (Complete Pain Specialists)
• Mouna Mihtar

• Sports Medicine (Family Medicine) Physician in Dearborn Heights, MI
• Providers in Dearborn Heights, MI by specialty
• Sports Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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.