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General NPI Number Information
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NPI Number | 1205937786
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Entity Type | Organization
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Legal Business Name | ALLERGY IMMUNOLOGY AND PULMONARY CRITICAL CARE PC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 950 W AVON RD SUITE A2
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-2761
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Country | US
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Telephone | 248-651-6430
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Fax | 248-650-1382
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Provider Business Mailing Address
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Address Line | 950 W AVON RD SUITE A2
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-2761
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Country | US
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Telephone | 248-651-6430
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Fax | 248-650-1382
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Authorized Official
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Title or Position | OWNER
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Name | IBRAHIM AL-SANOURI
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Credential | MD
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Telephone | 248-651-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 207RP1001X
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License Number State | MI
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