Provider Demographics
NPI:1104858794
Name:AL-DABAGH, AHMAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:S
Last Name:AL-DABAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5031 VILLA LINDE PKWY
Mailing Address - Street 2:STE 34
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3400
Mailing Address - Country:US
Mailing Address - Phone:810-733-8105
Mailing Address - Fax:810-733-8135
Practice Address - Street 1:5031 VILLA LINDE PKWY
Practice Address - Street 2:STE 34
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3446
Practice Address - Country:US
Practice Address - Phone:810-733-8105
Practice Address - Fax:810-733-8135
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301746Medicaid
MI1102504361OtherBLUE CROSS BLUE SHIELD
MI4301746Medicaid
MI1102504361OtherBLUE CROSS BLUE SHIELD