Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35.130400 | OH |
N | 111NI0900X | Internist | 35.130400 | OH |
N | 207R00000X | Internist | 4301105255 | MI |
N | 111NI0900X | Internist | 4301105255 | MI |
Y | 207RN0300X | Nephrologist | 4301105255 | MI |
NPI | 1063831758 |
---|---|
Provider Name | Mhd Hussam Al Jandali |
First Address | West Bloomfield, MI 48322-1308 |
Second Address | Detroit, MI 48202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 02/12/2021 |