Provider Demographics
NPI:1114687225
Name:DERBALA INSTITUTE FOR REPRODUCTIVE IMMUNOLOGY, PLLC
Entity Type:Organization
Organization Name:DERBALA INSTITUTE FOR REPRODUCTIVE IMMUNOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-676-6196
Mailing Address - Street 1:20480 VERNIER RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1411
Mailing Address - Country:US
Mailing Address - Phone:248-938-0141
Mailing Address - Fax:
Practice Address - Street 1:20480 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1411
Practice Address - Country:US
Practice Address - Phone:248-938-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty