Organization
WARREN GASTROENTEROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHAITH M IBRAHIM MD (PRESIDENT)
(586) 757-6400
Entity
Organization
Contact information
Practice address
27560 HOOVER RD, WARREN, MI 48093-4505
(586) 757-6400
(586) 757-8400
Mailing address
PO BOX 1920, TROY, MI 48099-1920
(586) 757-6400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
MI
207RG0100X
Gastroenterology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4813806
—
MI
Enumeration date
06/06/2007
Last updated
03/16/2010
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