Healthcare Provider Details

I. General information

NPI: 1538519913
Provider Name (Legal Business Name): FATIMAH IBRAHIM ALRUWAII MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

350 W 11TH ST RM 4083
INDIANAPOLIS IN
46202-4108
US

V. Phone/Fax

Practice location:
  • Phone: 800-653-6568
  • Fax: 313-876-1305
Mailing address:
  • Phone: 317-491-6213
  • Fax: 317-491-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11018626A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number4301505860
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301505860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: