Healthcare Provider Details

I. General information

NPI: 1588407555
Provider Name (Legal Business Name): ALAA SEYHIBRAHIM MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 03/20/2025
Certification Date:
Deactivation Date: 01/31/2025
Reactivation Date: 03/20/2025

III. Provider practice location address

3535 W 13 MILE RD
ROYAL OAK MI
48073
US

IV. Provider business mailing address

2400 COOLIDGE HWY APT. 203 UNIT #053203
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax: 248-551-2032
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351052348APP4
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: