Provider Demographics
NPI:1922431808
Name:SAM AJLUNI, M.D. PLLC
Entity type:Organization
Organization Name:SAM AJLUNI, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AJLUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:248-808-4644
Mailing Address - Street 1:26677 W. 12 MILE RD PMB 3272
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-808-4644
Mailing Address - Fax:248-288-3770
Practice Address - Street 1:26677 W. 12 MILE RD PMB 3272
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-808-4644
Practice Address - Fax:248-288-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty