Provider Demographics
NPI:1689643124
Name:NAOUMI, MANHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANHAL
Middle Name:
Last Name:NAOUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANHAL
Other - Middle Name:
Other - Last Name:NAOUMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:31500 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1057
Mailing Address - Country:US
Mailing Address - Phone:586-939-9500
Mailing Address - Fax:586-939-9501
Practice Address - Street 1:31500 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1057
Practice Address - Country:US
Practice Address - Phone:586-939-9500
Practice Address - Fax:586-939-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMN079004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI150795OtherGREAT LAKES HEALTH PLAN
MII31814OtherHAP
MI4735933Medicaid
MI141710OtherCARE CHOICES
MI0808261442OtherBCBS
MI0808261442OtherBLUE CARE NETWORK
MI271421112OtherTAX ID
MIP10980003Medicare PIN
MI0808261442OtherBCBS