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General NPI Number Information
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NPI Number | 1699724559
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Entity Type | Organization
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Legal Business Name | RIVERSIDE OB GYN P C
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 2275 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2114
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Country | US
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Telephone | 734-675-7210
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Fax | 734-675-3023
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Provider Business Mailing Address
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Address Line | 2275 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2114
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Country | US
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Telephone | 734-675-7210
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Fax | 734-675-3023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AHMAD I. AL-JERDI
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Credential | D.O.
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Telephone | 734-675-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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