Provider Demographics
NPI:1841400330
Name:MIRA, ALAAELDIN AHMED (MD)
Entity Type:Individual
Prefix:
First Name:ALAAELDIN
Middle Name:AHMED
Last Name:MIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 LINCOLN LN
Mailing Address - Street 2:#301
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2982
Mailing Address - Country:US
Mailing Address - Phone:313-828-1759
Mailing Address - Fax:
Practice Address - Street 1:OAKWOOD HEALTHCARE CENTER MERCURY DRIVE
Practice Address - Street 2:4900 MERCURY DRIVE, SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088157207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine