1902428832 NPI number — MUHANAD ABOU TOUK M.D

Table of content: MUHANAD ABOU TOUK M.D (NPI 1902428832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902428832 NPI number — MUHANAD ABOU TOUK M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABOU TOUK
Provider First Name:
MUHANAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1902428832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/17/2022
NPI Reactivation Date:
02/22/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 ST, ANTOINE, DETROIT MEDICAL CENTER, GME OFFICE
Provider Second Line Business Mailing Address:
UHC-9C
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-5146
Provider Business Mailing Address Fax Number:
313-966-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61104-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
779-696-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036165333 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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