Healthcare Provider Details

I. General information

NPI: 1174591549
Provider Name (Legal Business Name): MAJDA A HANNISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAJDA A ARAFAT-HANNISH

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W BIG BEAVER RD STE 110
TROY MI
48084
US

IV. Provider business mailing address

130 TOWN CENTER DR STE 203
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-816-1300
  • Fax: 248-816-2723
Mailing address:
  • Phone: 248-585-8265
  • Fax: 248-585-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: