Provider Demographics
NPI:1023067063
Name:AL-JERDI, AHMAD I (DO)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:I
Last Name:AL-JERDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2275 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2114
Mailing Address - Country:US
Mailing Address - Phone:734-675-7210
Mailing Address - Fax:734-675-3023
Practice Address - Street 1:2275 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2114
Practice Address - Country:US
Practice Address - Phone:734-675-7210
Practice Address - Fax:734-675-3023
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012046207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5820554OtherBLUE PREFERRED PLUS
MI160055737OtherRAILROAD MEDICARE
MI382524226OtherPPOM
MI382524226OtherTHE CHANDLER GROUP PRIMA
MI382524226OtherTRICARE EXTRA, STANDARD,
MI173659OtherONE HEALTH PLAN GREAT WES
MI4106545-11Medicaid
MI5409385OtherCCN
MI122747OtherPREFERRED CHOICES PPO
MI5164734OtherAETNA
MIG84901OtherHAP & HAP SENIOR PLUS
MI382524226OtherBCE EMERGIS
MI1209778OtherFIRST HEALTH
MI2966851OtherCIGNA
MI382524226OtherUNITED HEALTHCARE
MI5820554OtherBCBS PPO
MIP99325OtherBCN
MIM84380003Medicare PIN
MI382524226OtherPPOM
MI5820554OtherBCBS PPO