Provider Demographics
NPI:1093796922
Name:ABBOU, MUSHTAK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSHTAK
Middle Name:A
Last Name:ABBOU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-288-2230
Mailing Address - Fax:248-288-5450
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE 301
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2230
Practice Address - Fax:248-288-5450
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-10-05
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Provider Licenses
StateLicense IDTaxonomies
MI4301052220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48898Medicare UPIN
06333108161Medicare ID - Type Unspecified