1457308702 NPI number — MR. MUHAMMAD M ABOUDAN MD

Table of content: MR. MUHAMMAD M ABOUDAN MD (NPI 1457308702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457308702 NPI number — MR. MUHAMMAD M ABOUDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABOUDAN
Provider First Name:
MUHAMMAD
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457308702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8220 S. SAGINAW ST. STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-1890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-695-5864
Provider Business Mailing Address Fax Number:
810-695-2412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 S SAGINAW ST
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-695-5864
Provider Business Practice Location Address Fax Number:
810-695-2412
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  MA085139 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: MA085139 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MA085139 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5459129 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4751409 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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