1154768117 NPI number — MRS. IHTIRAM AHMED ALMASMARY M.D.

Table of content: MRS. IHTIRAM AHMED ALMASMARY M.D. (NPI 1154768117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154768117 NPI number — MRS. IHTIRAM AHMED ALMASMARY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALMASMARY
Provider First Name:
IHTIRAM
Provider Middle Name:
AHMED
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154768117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 TOWN CENTER DR STE 203
Provider Second Line Business Mailing Address:
BEAUMONT MEDICAL STAFF AFFAIRS
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-1744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15540 BEECH DALY RD
Provider Second Line Business Practice Location Address:
BOTSFORD MEDICAL CENTER-REDFORD
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48239-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-387-5253
Provider Business Practice Location Address Fax Number:
313-387-5263
Provider Enumeration Date:
05/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301103134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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