Executive Plaza Medical, P.C.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

5101006652 Issued in MI

Legal business name

EXECUTIVE PLAZA MEDICAL, P.C.

Practice address

17000 Executive Plaza Dr
Suite 103
Dearborn, MI 48126-2793

Phone

(313) 915-4632

Fax

(313) 915-4634

NPI assigned

Jun 16, 2014

Last updated

Jan 13, 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

Hossam A Hossein

Title

Manager

Phone

(313) 915-4632

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1952715153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR",
            "address_2": "SUITE 103",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-915-4632",
            "fax_number": "313-915-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 EXECUTIVE PLAZA DR",
            "address_2": "SUITE 103",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262793",
            "telephone_number": "313-915-4632",
            "fax_number": "313-915-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PLAZA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "HOSSEIN",
        "authorized_official_first_name": "HOSSAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-915-4632"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101006652",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MI",
            "license": "5101006652",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MI",
            "license": "4301405559",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MI",
            "license": "4301405324",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Executive Diagnostic Group, PLLC
• Executive Health PC
• Executive Infusion Services LLC (Executive Infusion Services)
• Executive Infusion Services LLC
• Executive Medical Center PLLC
• Express Health Urgent Care of Dearborn PLLC
• Express Home Health Care Inc
• Eyecare Professionals of Michigan
• Ez Scripts LLC
• Samir Ezzat, MD

• Multi-Specialty Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.