Healthcare Provider Details

I. General information

NPI: 1528026424
Provider Name (Legal Business Name): AMMAR GHANEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIR STE 205
ROCHESTER HILLS MI
48307-5821
US

IV. Provider business mailing address

75 BARCLAY CIR STE 205
ROCHESTER HILLS MI
48307-5821
US

V. Phone/Fax

Practice location:
  • Phone: 260-416-5892
  • Fax: 260-416-5897
Mailing address:
  • Phone: 248-651-6430
  • Fax: 260-416-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35085090
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01067395
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35085090
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01067395
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35085090
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301111042
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number01067395
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: