Provider Demographics
NPI:1104828201
Name:ABDRABBO, MOHAMMAD KHALOUCK (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHALOUCK
Last Name:ABDRABBO
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 1:10600 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4463
Mailing Address - Country:US
Mailing Address - Phone:513-853-9250
Mailing Address - Fax:
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4463
Practice Address - Country:US
Practice Address - Phone:513-853-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055436207RG0100X
OH35.143765207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4744440Medicaid
MI300207909OtherTAX ID
MI0N79640004Medicare ID - Type UnspecifiedMEDICARE
MI4744440Medicaid