Healthcare Provider Details

I. General information

NPI: 1194431817
Provider Name (Legal Business Name): ADVANCED ENT & ALLERGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 W WARREN AVE STE 201
DEARBORN MI
48126-8009
US

IV. Provider business mailing address

10645 W WARREN AVE STE 201
DEARBORN MI
48126-8009
US

V. Phone/Fax

Practice location:
  • Phone: 313-644-0020
  • Fax: 313-315-2011
Mailing address:
  • Phone: 313-644-0020
  • Fax: 313-315-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAHER SROUR
Title or Position: MD
Credential: MD
Phone: 313-644-0020