Provider Demographics
NPI:1447323829
Name:ALMOAYED, BOSHRA ABDULRAHMAN (MD)
Entity type:Individual
Prefix:
First Name:BOSHRA
Middle Name:ABDULRAHMAN
Last Name:ALMOAYED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4203
Mailing Address - Country:US
Mailing Address - Phone:313-770-5755
Mailing Address - Fax:313-483-9356
Practice Address - Street 1:1952 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2917
Practice Address - Country:US
Practice Address - Phone:313-770-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0359072084P0015X
VA01012404932084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine