1093452617 NPI number — MR. AHMAD RIYAD RADWAN DAMLAKHY M.D

Table of content: MR. AHMAD RIYAD RADWAN DAMLAKHY M.D (NPI 1093452617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093452617 NPI number — MR. AHMAD RIYAD RADWAN DAMLAKHY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMLAKHY
Provider First Name:
AHMAD
Provider Middle Name:
RIYAD RADWAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093452617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 ST. ANTOINE, UHC-9C
Provider Second Line Business Mailing Address:
DETROIT MEDICAL CENTER, GME OFFICE
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 ST. ANTOINE, UHC-9C
Provider Second Line Business Practice Location Address:
DETROIT MEDICAL CENTER, GME OFFICE
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-7434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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