Healthcare Provider Details

I. General information

NPI: 1952615932
Provider Name (Legal Business Name): NASSER ALI ALDHAIBANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3577 W 13 MILE RD
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

750 STEPHENSON HWY PAYOR CONTRACT SERVICES
TROY MI
48083-1103
US

V. Phone/Fax

Practice location:
  • Phone: 248-577-9700
  • Fax:
Mailing address:
  • Phone: 248-577-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301095788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: