Healthcare Provider Details

I. General information

NPI: 1154253920
Provider Name (Legal Business Name): AVICENNA MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 MAPLE ST STE A
DEARBORN MI
48126-3535
US

IV. Provider business mailing address

4353 MAPLE ST STE A
DEARBORN MI
48126-3535
US

V. Phone/Fax

Practice location:
  • Phone: 313-908-9004
  • Fax: 313-908-7873
Mailing address:
  • Phone: 313-908-9004
  • Fax: 313-908-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALEH AL-AMEEN
Title or Position: OWNER
Credential: MD
Phone: 313-908-9004