Basic Information
| Provider Information | |||||||||
| NPI: | 1598968547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALROAINI | ||||||||
| FirstName: | ABDULWAHHAB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15150 FORT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481951302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342824800 | ||||||||
| FaxNumber: | 7342829302 | ||||||||
| Practice Location | |||||||||
| Address1: | 15150 FORT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481951302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342824800 | ||||||||
| FaxNumber: | 7342829302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301081138 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 4301081138 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 4301081138 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 11808031 | 01 | MI | CAQH | OTHER | 5315053798 | 01 | MI | CDS # | OTHER | D0072852 | 01 | MI | MI STATE LICENSE # | OTHER | 4301081138 | 01 | MI | MICHIGAN LICENSE NUMBER | OTHER | P34850007 | 01 | MI | MEDICARE IND PIN # | OTHER | 1215129341 | 01 | MI | BCBS TYPE 1 NPI # | OTHER | 1598968547 | 05 | MI | MEDICAID |