1548430945 NPI number — THABET ABBARAH MD ENT PC

Table of content: (NPI 1548430945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548430945 NPI number — THABET ABBARAH MD ENT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THABET ABBARAH MD ENT PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1548430945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-7247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-681-3555
Provider Business Mailing Address Fax Number:
248-681-9809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 HIGHLAND RD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48328-2167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-681-3555
Provider Business Practice Location Address Fax Number:
248-681-9809
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ABBARAH
Authorized Official First Name:
THABET
Authorized Official Middle Name:
R
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
248-681-3555

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103539 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 605 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10-2699598 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-2738195 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006044 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10-2652878 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0P57370 . This is a "MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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