Provider Demographics
NPI:1073908869
Name:ALSHAMMAA, ABDULLAH (MD)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:ALSHAMMAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-8122
Mailing Address - Fax:517-432-3713
Practice Address - Street 1:804 SERVICE RD STE A217
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-353-8122
Practice Address - Fax:517-432-3713
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015078242084N0400X
TN610542084N0400X
MI43011071342084N0400X
OH35.1354082084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program