Provider Demographics
NPI:1740252089
Name:AMINI-OROUMI, LADAN (MD)
Entity type:Individual
Prefix:
First Name:LADAN
Middle Name:
Last Name:AMINI-OROUMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15450 NORTHLINE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2398
Mailing Address - Country:US
Mailing Address - Phone:734-282-2020
Mailing Address - Fax:734-282-2002
Practice Address - Street 1:15450 NORTHLINE RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2398
Practice Address - Country:US
Practice Address - Phone:734-282-2020
Practice Address - Fax:734-282-2002
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine