Basic Information
| Provider Information | |||||||||
| NPI: | 1689031932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULSAR MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17177 N LAUREL PARK DR | ||||||||
| Address2: | SUITE 439 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344620340 | ||||||||
| FaxNumber: | 7344620344 | ||||||||
| Practice Location | |||||||||
| Address1: | 27207 LAHSER RD | ||||||||
| Address2: | SUITE 200B | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480342168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487994300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2016 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | SIDDIQUE | ||||||||
| AuthorizedOfficialFirstName: | MOHAMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2484700421 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.