Provider Demographics
NPI:1144757949
Name:AL-GBURI, ISRAA ODAY GHANIM (MD)
Entity Type:Individual
Prefix:
First Name:ISRAA
Middle Name:ODAY GHANIM
Last Name:AL-GBURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LINKWOOD DRIVE
Mailing Address - Street 2:APT # 724
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025
Mailing Address - Country:US
Mailing Address - Phone:206-612-6626
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE, H-23
Practice Address - Street 2:ST. JOSEPH MERCY OAKLAND
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:206-612-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01090931A207R00000X
MIIN PROCESS207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264910428OtherMEDICARE PTAN
IN300078980Medicaid
IN183380159OtherMEDICARE PTAN