Provider Demographics
NPI:1245591338
Name:EXECUTIVE INFUSION SERVICES LLC
Entity Type:Organization
Organization Name:EXECUTIVE INFUSION SERVICES LLC
Other - Org Name:EXECUTIVE INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-523-5334
Mailing Address - Street 1:17000 EXECUTIVE PLAZA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2793
Mailing Address - Country:US
Mailing Address - Phone:313-982-3220
Mailing Address - Fax:313-982-3221
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2793
Practice Address - Country:US
Practice Address - Phone:313-982-3220
Practice Address - Fax:313-982-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 261QI0500X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336S0011X
MI53010100963336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135839OtherPK
MI7352700001Medicare UPIN