Provider Demographics
NPI:1679060099
Name:EL ALAYLI, AHMAD (MD)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:EL ALAYLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 WEST OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 MILITARY HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6407
Practice Address - Country:US
Practice Address - Phone:575-627-9500
Practice Address - Fax:575-627-9535
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2021-07-06
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2019-05-22
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2021-0301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program