Provider Demographics
NPI:1568121333
Name:INTENSIVE CARE ASSOCIATES
Entity Type:Organization
Organization Name:INTENSIVE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MHD
Authorized Official - Middle Name:HUSSAM
Authorized Official - Last Name:AL JANDALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-516-9850
Mailing Address - Street 1:6349 ALDINGBROOKE CIRCLE RD N STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1308
Mailing Address - Country:US
Mailing Address - Phone:248-318-7912
Mailing Address - Fax:
Practice Address - Street 1:3000 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-516-9850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty