Provider Demographics
NPI:1114214434
Name:AL-JEBAWI, YASSER (MD)
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:AL-JEBAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 N ALGER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1072
Mailing Address - Country:US
Mailing Address - Phone:989-463-2966
Mailing Address - Fax:989-463-5255
Practice Address - Street 1:7320 N ALGER RD
Practice Address - Street 2:SUITE G
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1072
Practice Address - Country:US
Practice Address - Phone:989-463-2966
Practice Address - Fax:989-463-5255
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104438208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program