Provider Demographics
NPI:1790797355
Name:AL-UJAYLI, BISHR ABDASSALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHR
Middle Name:ABDASSALAM
Last Name:AL-UJAYLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BISHR
Other - Middle Name:ABDASSALAM
Other - Last Name:UJAYLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1349 S ROCHESTER RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3150
Mailing Address - Country:US
Mailing Address - Phone:248-759-4852
Mailing Address - Fax:248-299-9860
Practice Address - Street 1:1349 S. ROCHESTER ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-759-4852
Practice Address - Fax:248-299-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054466207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11270493OtherCAQH PROVIDER ID
MI0F32901OtherBCBS OF MICHIGAN
MI5509OtherCAPE HEALTH
MI11645OtherMCARE HMO
MI4265425 10Medicaid
MI10059388004OtherWELLNESS PLAN
MI134440OtherCARE CHOICES
MI4301054466OtherSTATE LICENSE
MI11270493OtherCAQH PROVIDER ID
MI5509OtherCAPE HEALTH