Provider Demographics
NPI:1659362226
Name:ROUMAYAH-ELIA, SULAFA E (MD)
Entity Type:Individual
Prefix:DR
First Name:SULAFA
Middle Name:E
Last Name:ROUMAYAH-ELIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30701 WOODWARD AVE
Mailing Address - Street 2:SUITE 3-301
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0987
Mailing Address - Country:US
Mailing Address - Phone:248-541-2222
Mailing Address - Fax:248-541-7734
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:SUITE 3-301
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-541-2222
Practice Address - Fax:248-541-7734
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95991Medicare UPIN
0F36132Medicare ID - Type Unspecified