Provider Demographics
NPI:1164560595
Name:ABDELLATIF, ABDUL ALI (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:ALI
Last Name:ABDELLATIF
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:PO BOX 57926
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7926
Mailing Address - Country:US
Mailing Address - Phone:281-724-8296
Mailing Address - Fax:281-724-1858
Practice Address - Street 1:600 N KOBAYASHI STE 312
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8296
Practice Address - Fax:281-724-1858
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5007207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185826802Medicaid
TX185826801Medicaid
TX185826806Medicaid
TX185826801Medicaid
TX8J6562Medicare PIN
TXP00702245Medicare PIN
TX8J5006Medicare PIN