Provider Demographics
NPI:1336346030
Name:MICHIGAN INFECTIOUS DISEASE ASSOCIATES, PC
Entity type:Organization
Organization Name:MICHIGAN INFECTIOUS DISEASE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAREER
Authorized Official - Middle Name:SUHAIL
Authorized Official - Last Name:HMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-635-6702
Mailing Address - Street 1:13430 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-427-1351
Mailing Address - Fax:586-486-5669
Practice Address - Street 1:13430 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-427-1351
Practice Address - Fax:586-486-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDG0409Medicare PIN
MI0P45840Medicare PIN