Basic Information
| Provider Information | |||||||||
| NPI: | 1821225145 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AL-HOLOU | ||||||||
| FirstName: | WAJD | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346475299 | ||||||||
| FaxNumber: | 3137452777 | ||||||||
| Practice Location | |||||||||
| Address1: | 4160 JOHN R ST STE 925 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774867978 | ||||||||
| FaxNumber: | 3137452777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4301094343 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 363882701 (MDACC) | 05 | TX | MEDICAID |