Provider Demographics
NPI:1073628566
Name:BISHR UJAYLI MD PC
Entity Type:Organization
Organization Name:BISHR UJAYLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BISHR
Authorized Official - Middle Name:A
Authorized Official - Last Name:AL-UJAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-759-4852
Mailing Address - Street 1:1349 S. ROCHESTER ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3817
Mailing Address - Country:US
Mailing Address - Phone:248-759-4852
Mailing Address - Fax:248-299-9860
Practice Address - Street 1:1349 S. ROCHESTER ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-759-4852
Practice Address - Fax:248-299-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32901OtherBLUE CROSS BLUE SHIELD GROUP
DD1665OtherMEDICARE RAILROAD
DD1665OtherMEDICARE RAILROAD
MI0P02670Medicare PIN