Provider Demographics
NPI:1215380456
Name:BASIL ABDO MD PLLC
Entity Type:Organization
Organization Name:BASIL ABDO MD PLLC
Other - Org Name:ALFP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-561-9090
Mailing Address - Street 1:24224 JOY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1215
Mailing Address - Country:US
Mailing Address - Phone:313-561-9090
Mailing Address - Fax:313-561-3646
Practice Address - Street 1:24224 JOY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1215
Practice Address - Country:US
Practice Address - Phone:313-561-9090
Practice Address - Fax:313-561-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty