Provider Demographics
NPI:1083611172
Name:AJJOUR, MOHAMAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:K
Last Name:AJJOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4988
Mailing Address - Country:US
Mailing Address - Phone:586-776-8877
Mailing Address - Fax:586-776-3092
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-776-8877
Practice Address - Fax:586-776-3092
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045966207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01050OtherBCBS
MAP40297OtherBLUE CARE NETWORK
MIM018365OtherCHAMPUS GROUP
MI101033OtherCARE CHOICES
MI4515276OtherAETNA
MI2432983OtherCIGNA
MI2625084-10Medicaid
MI101033OtherPREFERRED CHOICES
MI101033OtherMERCY HEALTH PLANS
MI60042628OtherRAILROAD MEDICARE
MI2625084-10Medicaid
MAP40297OtherBLUE CARE NETWORK
MI0M25330Medicare PIN