1841383650 NPI number — JAWAD YOUSEF AGHA, M.D., P.L.L.C.

Table of content: (NPI 1841383650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841383650 NPI number — JAWAD YOUSEF AGHA, M.D., P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAWAD YOUSEF AGHA, M.D., P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841383650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 PONTIAC TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORCHARD LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48323-1566
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:
5301 MCAULEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-429-8539
Provider Business Practice Location Address Fax Number:
708-221-6174
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUSEF AGHA
Authorized Official First Name:
JAWAD
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
414-429-8539

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301076703 , 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)





Copyright © 2007-2024 www.npivalidator.com