Provider Demographics
NPI:1952503864
Name:ALBEIRUTI, EIYASS (MD)
Entity Type:Individual
Prefix:DR
First Name:EIYASS
Middle Name:
Last Name:ALBEIRUTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-719-3821
Mailing Address - Fax:616-719-3740
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 218
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-719-3821
Practice Address - Fax:616-719-3740
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084269207W00000X
PAMD438030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018248600Medicaid
MD018248600Medicaid