1790797355 NPI number — DR. BISHR ABDASSALAM AL-UJAYLI M.D.

Table of content: DR. BISHR ABDASSALAM AL-UJAYLI M.D. (NPI 1790797355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790797355 NPI number — DR. BISHR ABDASSALAM AL-UJAYLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-UJAYLI
Provider First Name:
BISHR
Provider Middle Name:
ABDASSALAM
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:
UJAYLI
Provider Other First Name:
BISHR
Provider Other Middle Name:
ABDASSALAM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790797355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1349 S ROCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-3150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-759-4852
Provider Business Mailing Address Fax Number:
248-299-9860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1349 S. ROCHESTER ROAD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-759-4852
Provider Business Practice Location Address Fax Number:
248-299-9860
Provider Enumeration Date:
08/12/2006

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: 207R00000X , with the licence number:  4301054466 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 4301054466 , 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: 11270493 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F32901 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5509 . This is a "CAPE HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11645 . This is a "MCARE HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4265425 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10059388004 . This is a "WELLNESS PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 134440 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301054466 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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