MEDICARE: DR. BISHR ABDASSALAM AL-UJAYLI 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	4301054466	MI
2	207RI0200X	Infectious Disease Physician	4301054466	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11270493	OTHER	MI	CAQH PROVIDER ID
2	0F32901	OTHER	MI	BCBS OF MICHIGAN
3	5509	OTHER	MI	CAPE HEALTH
4	11645	OTHER	MI	MCARE HMO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	10059388004	OTHER	MI	WELLNESS PLAN
7	134440	OTHER	MI	CARE CHOICES
8	4301054466	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1790797355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BISHR ABDASSALAM AL-UJAYLI M.D.

Provider Business Mailing Address
First Line	:	1349 S ROCHESTER RD
Second Line	:	SUITE 115
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3150
Country	:	US
Telephone Number	:	248-759-4852
Fax Number	:	248-299-9860

Provider Business Practice Location Address
First Line	:	1349 S. ROCHESTER ROAD
Second Line	:	SUITE 115
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-759-4852
Fax Number	:	248-299-9860

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/30/2013

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