Provider Demographics
NPI:1376857763
Name:WAFIE ROUMAYAH, MD, PC
Entity Type:Organization
Organization Name:WAFIE ROUMAYAH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WAFIE
Authorized Official - Middle Name:DANIAL
Authorized Official - Last Name:ROUMAYAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-544-7110
Mailing Address - Street 1:3345 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1635
Mailing Address - Country:US
Mailing Address - Phone:248-544-7110
Mailing Address - Fax:248-544-7112
Practice Address - Street 1:3345 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1635
Practice Address - Country:US
Practice Address - Phone:248-544-7110
Practice Address - Fax:248-544-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWR047991261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
330630892OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1671510Medicaid
MI1671510Medicaid