Healthcare Provider Details

I. General information

NPI: 1861483620
Provider Name (Legal Business Name): ALAA OWAINATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44200 WOODWARD AVE SUITE 210
PONTIAC MI
48341
US

IV. Provider business mailing address

44200 WOODWARD AVE SUITE 210
PONTIAC MI
48341
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-3930
  • Fax: 248-335-3933
Mailing address:
  • Phone: 248-335-3930
  • Fax: 248-335-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA0066999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: