Douaa H Al-Jebori, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Canton, MI
NPI 1467249581 · NPPES record last updated May 2, 2025
Key facts
- NPI
- 1467249581
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 4351053905 (MI)
- Practice address
- 1051 N Canton Center Rd
Canton, MI 48187-5097 - Phone
- (734) 998-2020
- NPI assigned
- Apr 22, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250618001884 | MI | Order and Referring Only - Internal Medicine |
4385155183 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351053905 | MI | MD | Student in an Organized Health Care Education/Training Program |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 4351053905 | MI | Yes |
Addresses
Primary practice location
1051 N Canton Center Rd
Canton, MI 48187-5097
Mailing address
1500 E Medical Center Dr SPC 5368
Ann Arbor, MI 48109-5368
Phone (734) 998-2020
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All providers in Canton, MI · Student in an Organized Health Care Education/Training Program in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.