Provider Demographics
NPI:1033876271
Name:COUNTY HEALTH SUPPORT SERVICES PLLC
Entity Type:Organization
Organization Name:COUNTY HEALTH SUPPORT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAZER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABDEL-FATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-922-4532
Mailing Address - Street 1:610 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3150
Mailing Address - Country:US
Mailing Address - Phone:313-314-0617
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2548
Practice Address - Country:US
Practice Address - Phone:231-922-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty