Provider Demographics
NPI:1669619748
Name:ROGER D AJLUNI MD PC
Entity type:Organization
Organization Name:ROGER D AJLUNI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:AJLUNI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:734-425-5200
Mailing Address - Street 1:17920 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3104
Mailing Address - Country:US
Mailing Address - Phone:734-425-5200
Mailing Address - Fax:734-425-7755
Practice Address - Street 1:17920 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3104
Practice Address - Country:US
Practice Address - Phone:734-425-5200
Practice Address - Fax:734-425-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082209261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care