Provider Demographics
NPI:1700888179
Name:AJLUNI, SAM K (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:K
Last Name:AJLUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 W 14 MILE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1714
Mailing Address - Country:US
Mailing Address - Phone:248-434-4111
Mailing Address - Fax:248-288-3770
Practice Address - Street 1:1800 W 14 MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1714
Practice Address - Country:US
Practice Address - Phone:248-434-4111
Practice Address - Fax:248-288-3770
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010721472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34953013Medicare ID - Type Unspecified
MIH38404Medicare UPIN