Provider Demographics
NPI:1427582311
Name:ABDELBAKI, DEYA (NP)
Entity Type:Individual
Prefix:
First Name:DEYA
Middle Name:
Last Name:ABDELBAKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 BELLEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3380
Mailing Address - Country:US
Mailing Address - Phone:734-699-9888
Mailing Address - Fax:
Practice Address - Street 1:11650 BELLEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3380
Practice Address - Country:US
Practice Address - Phone:734-699-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily