Provider Demographics
NPI:1508961590
Name:EL NACHEF, AMMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:EL NACHEF
Suffix:
Gender:M
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:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0348
Mailing Address - Country:US
Mailing Address - Phone:810-667-6411
Mailing Address - Fax:810-245-7803
Practice Address - Street 1:4053 S LAPEER RD
Practice Address - Street 2:SUITE D
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455
Practice Address - Country:US
Practice Address - Phone:810-667-6411
Practice Address - Fax:810-245-7803
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010734612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4082229Medicaid
253367OtherMCLAREN HEALTH PLAN
G85354Medicare UPIN
OM79870Medicare PIN