My Clinic PLLC

Key facts

NPI

1689216699

Entity type

Organization (NPI type 2)

Primary specialty

Internal Medicine Physician 207R00000X

Legal business name

MY CLINIC PLLC

Practice address

4025 Maple St Ste B
Dearborn, MI 48126-3532

Phone

(313) 269-4184

NPI assigned

Oct 10, 2019

Organization subpart

No

Authorized official

Name

Diana El Masri

Title

Credentialing Coordinator

Phone

(248) 215-0048

Practitioners 4

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

• Bilal Abdulla, NP Nurse Practitioner · Dearborn, MI · NPI 1912469701
  Medicare reassignment Care Compare group NPD MI
• Shukri Y Ashaweh, NP-BC Primary Care Nurse Practitioner · Farmington Hills, MI · NPI 1750944633
  Medicare reassignment Care Compare group NPD MI
• Aishah Gabbar Primary Care Nurse Practitioner · Melvindale, MI · NPI 1992683304
  Medicare reassignment Care Compare group NPD MI
• Amir Jundi, M.D. Nephrology Physician · Dearborn, MI · NPI 1134378854
  Medicare reassignment NPD INTERNAL MEDICINE · MI

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 10, 2019.

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1689216699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 MAPLE ST STE B",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263532",
            "telephone_number": "313-269-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 MAPLE ST STE B",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263532",
            "telephone_number": "313-269-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "EL MASRI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "248-215-0048"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Dearborn, MI · Internal Medicine Physician in Michigan