Provider Demographics
NPI:1457335713
Name:ALOSACHIE, IYAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:IYAD
Middle Name:J
Last Name:ALOSACHIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23411 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1404
Mailing Address - Country:US
Mailing Address - Phone:248-399-6777
Mailing Address - Fax:248-399-3912
Practice Address - Street 1:23411 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1404
Practice Address - Country:US
Practice Address - Phone:248-399-6777
Practice Address - Fax:248-399-3912
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135819OtherCARE-PREFERRED CHOICES
MI1457335713Medicaid
MIP00072773OtherRR MEDICARE
MIG54089OtherHAP
MI063 5901OtherBCBS PIN
MIG54089OtherHAP
MI1457335713Medicaid