Provider Demographics
NPI:1417070590
Name:ABU YASIN, FADI (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:ABU YASIN
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 1:47166 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2583
Mailing Address - Country:US
Mailing Address - Phone:313-974-2188
Mailing Address - Fax:313-344-7456
Practice Address - Street 1:47166 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2583
Practice Address - Country:US
Practice Address - Phone:313-974-2188
Practice Address - Fax:313-344-7456
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085478207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417070590Medicaid
MI1417070590Medicaid