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NPI Code Detail

MEDICARE: DR. AHMAD JALAL KANAWATI M.B.B.S.

MEDICARE: DR. AHMAD JALAL KANAWATI M.B.B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1437087723
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AHMAD JALAL KANAWATI M.B.B.S.
Provider Business Mailing Address
First Line : 22250 PROVIDENCE DRIVE 7PMB
Second Line : SUITE #703A
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-5862
Fax Number : 248-849-8117
Provider Business Practice Location Address
First Line : 22250 PROVIDENCE DRIVE 7PMB
Second Line : SUITE #703A
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-5862
Fax Number : 248-849-8117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2026
Last Update Date : 05/08/2026

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