Healthcare Provider Details

I. General information

NPI: 1629166582
Provider Name (Legal Business Name): ADNAN MUNKARAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL, K BUILDING- 9TH FLOOR
DETROIT MI
48202-2608
US

IV. Provider business mailing address

3031 W GRAND BLVD NEW CENTER ONE, 7TH FLOOR, WOMEN'S HEALTH DEPARTMENT
DETROIT MI
48202-3046
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2465
  • Fax: 313-916-1025
Mailing address:
  • Phone: 313-916-2493
  • Fax: 313-916-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number4301406838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: