Healthcare Provider Details

I. General information

NPI: 1497954598
Provider Name (Legal Business Name): RAMI ALZEBDEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE SUITE 105
JACKSON MI
49201-2457
US

IV. Provider business mailing address

900 E MICHIGAN AVE STE 105
JACKSON MI
49201-2490
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-3190
  • Fax:
Mailing address:
  • Phone: 517-782-3190
  • Fax: 517-782-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085814
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301085814
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301085814
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: