Healthcare Provider Details

I. General information

NPI: 1073628566
Provider Name (Legal Business Name): BISHR UJAYLI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
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 ROAD SUITE 115
ROCHESTER HILLS MI
48307-3817
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 Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BISHR A. AL-UJAYLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-759-4852