Provider Demographics
NPI:1649451964
Name:CEDAR MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CEDAR MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADI
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHORAYEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-5757
Mailing Address - Street 1:1951 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2916
Mailing Address - Country:US
Mailing Address - Phone:313-563-5757
Mailing Address - Fax:313-563-5760
Practice Address - Street 1:1951 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2916
Practice Address - Country:US
Practice Address - Phone:313-563-5757
Practice Address - Fax:313-563-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG078483202K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H232600OtherBCN
MI110H232600OtherBC/BS
MI110H232600OtherBC/BS
MI110H232600OtherBCN