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1457335713

NPI Code Detail

MEDICARE: DR. IYAD J ALOSACHIE M.D.

MEDICARE: DR. IYAD J ALOSACHIE M.D.

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
1	207R00000X	Internal Medicine Physician	4301064763	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00072773	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135819	OTHER	MI	CARE-PREFERRED CHOICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	G54089	OTHER	MI	HAP
5	063 5901	OTHER	MI	BCBS PIN

General Provider Information

NPI Number	:	1457335713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IYAD J ALOSACHIE M.D.

Provider Business Mailing Address
First Line	:	23411 JOHN R RD
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1404
Country	:	US
Telephone Number	:	248-399-6777
Fax Number	:	248-399-3912

Provider Business Practice Location Address
First Line	:	23411 JOHN R RD
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1404
Country	:	US
Telephone Number	:	248-399-6777
Fax Number	:	248-399-3912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	05/21/2010

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Directions to “ DR. IYAD J ALOSACHIE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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