Provider Demographics
NPI:1518923382
Name:ABDEL FATTAH, NAZER (DO)
Entity Type:Individual
Prefix:DR
First Name:NAZER
Middle Name:
Last Name:ABDEL FATTAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22171 NOWLIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2732
Mailing Address - Country:US
Mailing Address - Phone:313-414-3545
Mailing Address - Fax:313-383-5555
Practice Address - Street 1:15101 SOUTHFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2697
Practice Address - Country:US
Practice Address - Phone:313-383-3333
Practice Address - Fax:313-383-5555
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012667207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI02-0585039OtherTAX ID
MI4404850Medicaid
G65456Medicare UPIN