Provider Demographics
NPI:1467502294
Name:HAWASLI, ABDELKADER (MD)
Entity Type:Individual
Prefix:
First Name:ABDELKADER
Middle Name:
Last Name:HAWASLI
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 1:24911 LITTLE MACK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3200
Mailing Address - Country:US
Mailing Address - Phone:586-774-8811
Mailing Address - Fax:586-774-8811
Practice Address - Street 1:24911 LITTLE MACK AVE
Practice Address - Street 2:STE B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3200
Practice Address - Country:US
Practice Address - Phone:586-774-8811
Practice Address - Fax:586-774-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044113208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932957Medicaid
MIN93220001Medicare ID - Type Unspecified
MI1932957Medicaid