1023067063 NPI number — DR. AHMAD I AL-JERDI D.O.

Table of content: DR. AHMAD I AL-JERDI D.O. (NPI 1023067063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023067063 NPI number — DR. AHMAD I AL-JERDI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-JERDI
Provider First Name:
AHMAD
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1023067063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 W JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-675-7210
Provider Business Mailing Address Fax Number:
734-675-3023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-7210
Provider Business Practice Location Address Fax Number:
734-675-3023
Provider Enumeration Date:
05/08/2006

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: 207V00000X , with the licence number:  5101012046 , 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)

  • Identifier: 5820554 . This is a "BLUE PREFERRED PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160055737 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "THE CHANDLER GROUP PRIMA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "TRICARE EXTRA, STANDARD," identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 173659 . This is a "ONE HEALTH PLAN GREAT WES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4106545-11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5409385 . This is a "CCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 122747 . This is a "PREFERRED CHOICES PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5164734 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G84901 . This is a "HAP & HAP SENIOR PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "BCE EMERGIS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1209778 . This is a "FIRST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2966851 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382524226 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5820554 . This is a "BCBS PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P99325 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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