Provider Demographics
NPI:1134101074
Name:ABDALLA-ALI, ABDALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDALLA
Middle Name:
Last Name:ABDALLA-ALI
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 1:804 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:517-364-5440
Mailing Address - Fax:517-364-5409
Practice Address - Street 1:1200 E MICHIGAN AVE STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1897
Practice Address - Country:US
Practice Address - Phone:517-364-5440
Practice Address - Fax:517-364-5409
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI203742OtherMCLAREN HEALTH PLAN
MI203742OtherHEALTH ADVANTAGE NETWORK
MI5517663OtherAETNA
MI330485OtherBLUE CROSS BLUE SHIELD
MI1200183OtherPHYSICIANS HEALTH PLAN
MI350D410030OtherCOMMUNITY BLUE PPO
MI4871668Medicaid
MI350D410030OtherBLUE CHOICE
MI350C361520OtherBLUE CROSS BLUE SHIELD
MI350D410030OtherBLUE CARE NETWORK
MI350D410030OtherBLUE CROSS BLUE SHIELD
MI4155272Medicaid
MI4416510Medicaid
MIG87637OtherHEALTH NET FED SERVICES
MI5517663OtherAETNA
MI203742OtherHEALTH ADVANTAGE NETWORK