| Scope Medical Group Pllc | |
|
50 N Perry St Pontiac MI 48342-2217 | |
| (708) 586-2080 | |
| Not Available |
| Full Name | Scope Medical Group Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 50 N Perry St, Pontiac, Michigan |
| Authorized Official Name and Position | Mohanad Suede (OWNER) |
| Authorized Official Contact | 3137790406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scope Medical Group Pllc 6088 Glen Eagles Dr West Bloomfield MI 48323-2212 Ph: () - | Scope Medical Group Pllc 50 N Perry St Pontiac MI 48342-2217 Ph: (708) 586-2080 |
| NPI Number | 1841940905 |
|---|---|
| Provider Enumeration Date | 03/23/2022 |
| Last Update Date | 03/23/2022 |
| Medicare PECOS PAC ID | 3779953757 |
|---|---|
| Medicare Enrollment ID | O20230109001454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841940905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Susan Wolgamott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760894638 PECOS PAC ID: 0941428080 Enrollment ID: I20140902001581 |
| Provider Name | Mohanad Suede |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1720436843 PECOS PAC ID: 3476847898 Enrollment ID: I20181015002295 |
| Provider Name | Kyle Edward Antosiek |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376926972 PECOS PAC ID: 2062703101 Enrollment ID: I20220426002016 |
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