Provider Demographics
NPI:1497118244
Name:HIJAZI, AHMAD (DO)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:HIJAZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 PEARL ST
Mailing Address - Street 2:APT B11
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7046
Mailing Address - Country:US
Mailing Address - Phone:313-713-1696
Mailing Address - Fax:
Practice Address - Street 1:4825 WESTLAND ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4112
Practice Address - Country:US
Practice Address - Phone:313-713-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013752207R00000X, 208M00000X
MS0000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357874Medicaid