Healthcare Provider Details

I. General information

NPI: 1154713782
Provider Name (Legal Business Name): ALOOL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 GREENFIELD RD
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

4726 GREENFIELD RD
DEARBORN MI
48126-4124
US

V. Phone/Fax

Practice location:
  • Phone: 315-491-4916
  • Fax:
Mailing address:
  • Phone: 315-491-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301090195
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301090195
License Number StateMI

VIII. Authorized Official

Name: DR. EDWARD ALOUL
Title or Position: OWNER
Credential: M.D
Phone: 315-491-4916