Basic Information
| Provider Information | |||||||||
| NPI: | 1073628566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BISHR UJAYLI MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1349 S. ROCHESTER ROAD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483073817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487594852 | ||||||||
| FaxNumber: | 2482999860 | ||||||||
| Practice Location | |||||||||
| Address1: | 1349 S. ROCHESTER ROAD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483073817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487594852 | ||||||||
| FaxNumber: | 2482999860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | AL-UJAYLI | ||||||||
| AuthorizedOfficialFirstName: | BISHR | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2487594852 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 0F32901 | 01 | MI | BLUE CROSS BLUE SHIELD GROUP | OTHER | DD1665 | 01 | MEDICARE RAILROAD | OTHER |