1790737799 NPI number — DR. HUSSEIN A HURAIBI M.D.

Table of content: DR. HUSSEIN A HURAIBI M.D. (NPI 1790737799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790737799 NPI number — DR. HUSSEIN A HURAIBI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURAIBI
Provider First Name:
HUSSEIN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1790737799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-0966
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:
11650 BELLEVILLE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN BUREN TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48111-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-699-9888
Provider Business Practice Location Address Fax Number:
734-325-6430
Provider Enumeration Date:
05/17/2006

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: 207L00000X , with the licence number:  4301066286 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 4301066286 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11279065 . This is a "CAQH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P12330001 . This is a "MEDICARE IND PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1790737799 . This is a "BCBS TYPE 1 (IND) NPI #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301066286 . This is a "STATE LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 470874910 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5315057615 . This is a "CDS #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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