Healthcare Provider Details

I. General information

NPI: 1790797355
Provider Name (Legal Business Name): BISHR ABDASSALAM AL-UJAYLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BISHR ABDASSALAM UJAYLI M.D.

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S. ROCHESTER ROAD SUITE 115
ROCHESTER HILLS MI
48307-3817
US

IV. Provider business mailing address

1349 S ROCHESTER RD SUITE 115
ROCHESTER HILLS MI
48307-3150
US

V. Phone/Fax

Practice location:
  • Phone: 248-759-4852
  • Fax: 248-299-9860
Mailing address:
  • Phone: 248-759-4852
  • Fax: 248-299-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301054466
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301054466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: