Provider Demographics
NPI:1477707305
Name:ROYAL HOME VISTING PHYSICIANS, P.C.
Entity type:Organization
Organization Name:ROYAL HOME VISTING PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DJAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-368-0668
Mailing Address - Street 1:3985 CANIFF ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3184
Mailing Address - Country:US
Mailing Address - Phone:313-368-0668
Mailing Address - Fax:313-368-0568
Practice Address - Street 1:3985 CANIFF ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3184
Practice Address - Country:US
Practice Address - Phone:313-368-0668
Practice Address - Fax:313-368-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175L00000X
MI4301039115261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407991615OtherBLUE CROSS
MI1407991615Medicaid
MI1407991615Medicaid