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General NPI Number Information
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NPI Number | 1477059087
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Entity Type | Organization
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Legal Business Name | DOCTORS HOME LINE PLLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 30500 VAN DYKE AVE SUITE 203
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City | WARREN
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State | MI
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Zip | 48093-2109
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Country | US
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Telephone | 248-480-9066
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Fax | 248-480-9062
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Provider Business Mailing Address
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Address Line | 30500 VAN DYKE AVE STE 203
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City | WARREN
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State | MI
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Zip | 48093-2109
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Country | US
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Telephone | 248-480-9066
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Fax | 248-480-9062
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHMMED YAZEED AL-SHIHABI
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Credential | MD
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Telephone | 517-812-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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