Provider Demographics
NPI:1437415122
Name:ALKHOORY, WAMIDH LUAY (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:WAMIDH
Middle Name:LUAY
Last Name:ALKHOORY
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:WAMIDH
Other - Middle Name:LUAY
Other - Last Name:ADWAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBCHB
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2600
Mailing Address - Fax:313-916-2385
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:313-916-2385
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101471207ZP0102X, 207ZP0105X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine