Provider Demographics
NPI:1730608514
Name:PIONEER PHYSICIAN SERVICES, INC.
Entity type:Organization
Organization Name:PIONEER PHYSICIAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:EZZAT
Authorized Official - Last Name:ABDEL KHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-283-7211
Mailing Address - Street 1:7227 CLOISTER RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-2213
Mailing Address - Country:US
Mailing Address - Phone:419-973-6365
Mailing Address - Fax:567-249-0045
Practice Address - Street 1:5901 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1841
Practice Address - Country:US
Practice Address - Phone:419-973-6365
Practice Address - Fax:567-249-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093093208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty