Organization
RIVERSIDE OB GYN P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AHMAD I. AL-JERDI D.O. (PRESIDENT)
(734) 675-7210
Entity
Organization
Contact information
Practice address
2275 W JEFFERSON AVE, TRENTON, MI 48183-2114
(734) 675-7210
(734) 675-3023
Mailing address
2275 W JEFFERSON AVE, TRENTON, MI 48183-2114
(734) 675-7210
(734) 675-3023
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1540358-11
—
MI
01
—
160003353
RAILROAD MEDICARE
MI
01
—
160055737
RAILROAD MEDICARE
MI
01
—
160055739
RAILROAD MEDICARE
MI
01
—
160059461
RAILROAD MEDICARE
MI
01
—
160H210680
BCBS
MI
01
—
2966851
CIGNA
MI
05
—
4106545-11
—
MI
05
—
4165045-10
—
MI
05
—
4471183-11
—
MI
01
—
6676861
CIGNA
MI
01
—
7139017
CIGNA
MI
Enumeration date
05/09/2006
Last updated
06/26/2012
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