Healthcare Provider Details

I. General information

NPI: 1942756234
Provider Name (Legal Business Name): AHMED ALRAJJAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 CALVIN AVENUE
GROSSE POINTE FARMS MI
48236-3236
US

IV. Provider business mailing address

459 CALVIN AVE
GROSSE POINTE FARMS MI
48236-3236
US

V. Phone/Fax

Practice location:
  • Phone: 832-866-8463
  • Fax: 313-343-8318
Mailing address:
  • Phone: 832-866-8463
  • Fax: 313-343-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301107920
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301116935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: