Basic Information
| Provider Information | |||||||||
| NPI: | 1558666891 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ISMAIL B SENDI MD, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW OAKLAND CHILD ADOLESCENT AND FAMILY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12850 FOUNTAIN SQ | ||||||||
| Address2: | STE 106 | ||||||||
| City: | DAVISBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483502552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486346303 | ||||||||
| FaxNumber: | 2486341746 | ||||||||
| Practice Location | |||||||||
| Address1: | 26522 VAN DYKE AVE | ||||||||
| Address2: | |||||||||
| City: | CENTER LINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480151221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486346303 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SENDI | ||||||||
| AuthorizedOfficialFirstName: | ISMAIL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2486346303 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 750910681 | 01 | MI | BLUE CROSS BLUE SHIELD MICHIGAN | OTHER | 018954 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | 0910932 | 01 | MI | BLUE CARE NETWORK | OTHER | 5055 | 01 | MI | MACOMB COUNTY CMH | OTHER | XX19153 | 01 | MI | HEALTHPLUS | OTHER |