Healthcare Provider Details

I. General information

NPI: 1134312804
Provider Name (Legal Business Name): ADNAN AHMED AL-DAIS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 10/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 W WARREN AVE STE 300
DEARBORN MI
48126-1782
US

IV. Provider business mailing address

2713 ROULO ST
DEARBORN MI
48120-1544
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-9446
  • Fax: 313-581-9448
Mailing address:
  • Phone: 313-522-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301091059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: