Provider Demographics
NPI:1013598820
Name:MATTIT, ABDULLAH
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:MATTIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3310
Mailing Address - Country:US
Mailing Address - Phone:313-898-1921
Mailing Address - Fax:
Practice Address - Street 1:49485 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3206
Practice Address - Country:US
Practice Address - Phone:734-354-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy