Provider Demographics
NPI:1083112486
Name:HAGROO, ABDUL
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:HAGROO
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 1:2855 COOLIDGE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3215
Mailing Address - Country:US
Mailing Address - Phone:248-649-6380
Mailing Address - Fax:248-649-6381
Practice Address - Street 1:2855 COOLIDGE HWY STE 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3215
Practice Address - Country:US
Practice Address - Phone:248-649-6380
Practice Address - Fax:248-649-6381
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI270943719OtherMERIDIAN
MI270943719Medicaid