Provider Demographics
NPI:1184651374
Name:AJLUNI, PETER B (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:AJLUNI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21620 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2319
Mailing Address - Country:US
Mailing Address - Phone:586-469-8300
Mailing Address - Fax:
Practice Address - Street 1:21620 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2319
Practice Address - Country:US
Practice Address - Phone:586-469-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006062207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1418001Medicaid
MIOM77410Medicare ID - Type Unspecified
MIE26469Medicare UPIN