Provider Demographics
NPI:1801053244
Name:MOHAMAD AL-JARRAH M D P C
Entity type:Organization
Organization Name:MOHAMAD AL-JARRAH M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-JARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-978-1300
Mailing Address - Street 1:PO BOX 3396
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3396
Mailing Address - Country:US
Mailing Address - Phone:586-978-1300
Mailing Address - Fax:586-978-1303
Practice Address - Street 1:36909 SCHOENHERR RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3371
Practice Address - Country:US
Practice Address - Phone:586-978-1300
Practice Address - Fax:586-978-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207RP1001X
MI4301057471207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3503774Medicaid
MI110825139OtherBCBS
MIP61438OtherBCN
MIG40626Medicare UPIN
MI0M69780Medicare PIN