Provider Demographics
NPI:1508239104
Name:ABDULGADIR ADAM MD PLLC
Entity Type:Organization
Organization Name:ABDULGADIR ADAM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDULGADIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-355-7044
Mailing Address - Street 1:234 E CANFORD PARK
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6670
Mailing Address - Country:US
Mailing Address - Phone:734-355-7044
Mailing Address - Fax:
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-556-5582
Practice Address - Fax:248-850-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076176207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty