Provider Demographics
NPI:1669549820
Name:ALAA OWAINATI MD PC
Entity type:Organization
Organization Name:ALAA OWAINATI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWAINATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-3930
Mailing Address - Street 1:43700 WOODWARD AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5058
Mailing Address - Country:US
Mailing Address - Phone:248-335-3930
Mailing Address - Fax:248-335-3933
Practice Address - Street 1:43700 WOODWARD AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5058
Practice Address - Country:US
Practice Address - Phone:248-335-3930
Practice Address - Fax:248-335-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAO066999207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4269540Medicaid
MI0P28170Medicare ID - Type Unspecified
MI4269540Medicaid