Provider Demographics
NPI:1356783088
Name:PARAMOUNT MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:PARAMOUNT MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-757-6400
Mailing Address - Street 1:27560 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4505
Mailing Address - Country:US
Mailing Address - Phone:586-757-6400
Mailing Address - Fax:586-757-0763
Practice Address - Street 1:27560 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4505
Practice Address - Country:US
Practice Address - Phone:586-757-6400
Practice Address - Fax:586-757-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D2023134291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E03492OtherBLUE CROSS
MI700E03492OtherBLUE CROSS