Provider Demographics
NPI:1346826849
Name:ABAZID, HEBA S
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:S
Last Name:ABAZID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25748 GRACELAND CIR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1067
Mailing Address - Country:US
Mailing Address - Phone:313-333-1364
Mailing Address - Fax:
Practice Address - Street 1:25748 GRACELAND CIR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1067
Practice Address - Country:US
Practice Address - Phone:313-333-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326175NSA2107P363L00000X
MI4704326175363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner