Provider Demographics
NPI:1972592582
Name:ALAIWAT, MUNTHER K (MD)
Entity type:Individual
Prefix:DR
First Name:MUNTHER
Middle Name:K
Last Name:ALAIWAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:15675 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2334
Practice Address - Country:US
Practice Address - Phone:734-282-3600
Practice Address - Fax:734-282-3603
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-10-05
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Provider Licenses
StateLicense IDTaxonomies
MI4301069255207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24657OtherBLUE CROSS
MI3354262Medicaid
MI3354262Medicaid
MIQ24657065Medicare PIN