1568809945 NPI number — MARIHAM O GIRGIS MA TLLP

Table of content: MARIHAM O GIRGIS MA TLLP (NPI 1568809945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568809945 NPI number — MARIHAM O GIRGIS MA TLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIRGIS
Provider First Name:
MARIHAM
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA TLLP
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:
1568809945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
468 FOX HILLS DR S
Provider Second Line Business Mailing Address:
APT 5
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304-1355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-312-8478
Provider Business Mailing Address Fax Number:
586-263-5311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42621 GARFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-5031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-3312
Provider Business Practice Location Address Fax Number:
586-263-5311
Provider Enumeration Date:
05/27/2013

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: 103TC1900X , with the licence number:  6301015485 , 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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