Provider Demographics
NPI:1477591139
Name:METWALLY, NABIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:M
Last Name:METWALLY
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 1:39353 HEATHERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24224 JOY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1215
Practice Address - Country:US
Practice Address - Phone:313-565-6663
Practice Address - Fax:313-565-6632
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064169207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF08669Medicare UPIN
MIP38590002Medicare PIN
MIM60660147Medicare PIN
MI0N24770Medicare PIN
MINM064169OtherBC/BS
MI110223559OtherRAILROAD MEDICARE PALMETO
MI0P38590Medicare PIN
MI4088518Medicaid
MI4166946Medicaid
MI3252997Medicaid
MIP38590002Medicare PIN
MIF08669Medicare UPIN