Provider Demographics
NPI:1134312804
Name:AL-DAIS, ADNAN AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:AHMED
Last Name:AL-DAIS
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 1:2713 ROULO ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1544
Mailing Address - Country:US
Mailing Address - Phone:313-522-2374
Mailing Address - Fax:
Practice Address - Street 1:14650 W WARREN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1782
Practice Address - Country:US
Practice Address - Phone:313-581-9446
Practice Address - Fax:313-581-9448
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics