1619177995 NPI number — ADIL ARABBO

Table of content: (NPI 1619177995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619177995 NPI number — ADIL ARABBO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADIL ARABBO
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:
ADVANCED FAMILY CARE OF COMMERCE
Provider Other Organization Name Type Code:
3
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:
1619177995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4123 MARTIN RD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48390-4151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-366-3700
Provider Business Mailing Address Fax Number:
248-360-1760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4123 MARTIN RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
COMMERCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48390-4151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-366-3700
Provider Business Practice Location Address Fax Number:
248-360-1760
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARABBO
Authorized Official First Name:
ADIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
248-366-3700

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301065973 , 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: 1316936008 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0806345542 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1619177995 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4693360 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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