Basic Information
Provider Information
NPI: 1003806217
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAHAYNI
FirstName: RULA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 43700 WOODWARD AVE STE 103
Address2:  
City: BLOOMFIELD HILLS
State: MI
PostalCode: 483025060
CountryCode: US
TelephoneNumber: 2483324629
FaxNumber: 2483225490
Practice Location
Address1: 43700 WOODWARD AVE STE 103
Address2:  
City: BLOOMFIELD HILLS
State: MI
PostalCode: 483025060
CountryCode: US
TelephoneNumber: 2483324629
FaxNumber: 2483225490
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 11/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X4301056551MIY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
440634336101MIBLUE CROSSOTHER
317750605MI MEDICAID


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