Michigan Sports Medicine PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

4301095806 Issued in MI

Legal business name

MICHIGAN SPORTS MEDICINE PC

Practice address

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

Phone

(313) 562-4700

Fax

(313) 562-4701

NPI assigned

Apr 5, 2018

Organization subpart

No

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

Authorized official

Name

Tarek Salim Hadla, MDNPI 1568636629

Title

Physician/Auth Offical

Phone

(313) 562-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Tarek Salim Hadla, M.D.

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

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1487150686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23902 FORD RD STE 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 STE 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": "2018-04-05",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "HADLA",
        "authorized_official_first_name": "TAREK",
        "authorized_official_middle_name": "SALIM",
        "authorized_official_title_or_position": "PHYSICIAN/AUTH OFFICAL",
        "authorized_official_telephone_number": "313-562-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4301095806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCS/DME",
            "identifier": "6986550001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michigan Institute of Vascular and Interventional Radiology, 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
• Mouna Mihtar
• Amy Miller

• Durable Medical Equipment & Medical Supplies in Dearborn Heights, MI
• Providers in Dearborn Heights, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.