| Innovation Medicine, Pllc | |
|
25710 Kelly Rd Ste 3 Roseville MI 48066-4959 | |
| (586) 772-2600 | |
| Not Available |
| Full Name | Innovation Medicine, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 25710 Kelly Rd, Roseville, Michigan |
| Authorized Official Name and Position | Basem Almasri (PHYSICIAN) |
| Authorized Official Contact | 5867722600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovation Medicine, Pllc 25710 Kelly Rd Ste 3 Roseville MI 48066-4959 Ph: () - | Innovation Medicine, Pllc 25710 Kelly Rd Ste 3 Roseville MI 48066-4959 Ph: (586) 772-2600 |
| NPI Number | 1720511405 |
|---|---|
| Provider Enumeration Date | 04/10/2017 |
| Last Update Date | 12/12/2023 |
| Medicare PECOS PAC ID | 9537446497 |
|---|---|
| Medicare Enrollment ID | O20170501002208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720511405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RA0401X | Internal Medicine - Addiction Medicine | (* (Not Available)) | Secondary |
| Provider Name | Basem Almasri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326040510 PECOS PAC ID: 5698677284 Enrollment ID: I20040123000597 |
| Provider Name | Rudy Jerome Vervaeke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922108927 PECOS PAC ID: 6800886433 Enrollment ID: I20040515000418 |
| Provider Name | Osama Nicola Nunu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831191170 PECOS PAC ID: 6507893070 Enrollment ID: I20050726001036 |
| Provider Name | Borivoje M Trifunovic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730167644 PECOS PAC ID: 6507899671 Enrollment ID: I20050919000293 |
| Provider Name | Susanne Garay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952867905 PECOS PAC ID: 9739429358 Enrollment ID: I20190319000680 |
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