Provider Demographics
NPI:1326100660
Name:ABDELHAK, TAMER (MD)
Entity Type:Individual
Prefix:
First Name:TAMER
Middle Name:
Last Name:ABDELHAK
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 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:518-262-5226
Mailing Address - Fax:
Practice Address - Street 1:TRINITY HEALTH IHA MEDICAL GROUP NEUROLOGY
Practice Address - Street 2:5333 MCAULEY DRIVE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3412
Practice Address - Country:US
Practice Address - Phone:734-712-1400
Practice Address - Fax:734-623-2857
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010905612084A2900X, 2084N0400X
NJ25MA107799002084N0400X
WI72703-202084N0400X
MDD647112084N0400X
IL0361366912084N0400X
NY3021092084N0400X
IL036-1366912084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036136691Medicaid
IL036136691Medicaid
166686Medicare UPIN
166686Medicare UPIN