Provider Demographics
NPI:1235820648
Name:ABDALLAH, MUHANNED SALAH IMAM (MD)
Entity Type:Individual
Prefix:
First Name:MUHANNED
Middle Name:SALAH IMAM
Last Name:ABDALLAH
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 1:4201 ST. ANTOINE, STE 8C-UHC
Mailing Address - Street 2:WAYNE STATE SCHOOL OF MEDICINE-DEPARTMENT OF NEUROLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-1302
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTOINE, STE 8C-UHC
Practice Address - Street 2:WAYNE STATE SCHOOL OF MEDICINE-DEPARTMENT OF NEUROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty