Provider Demographics
NPI:1548430945
Name:THABET ABBARAH MD ENT PC
Entity Type:Organization
Organization Name:THABET ABBARAH MD ENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:THABET
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABBARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-681-3555
Mailing Address - Street 1:PO BOX 7247
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-7247
Mailing Address - Country:US
Mailing Address - Phone:248-681-3555
Mailing Address - Fax:248-681-9809
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE 115
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-681-3555
Practice Address - Fax:248-681-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103539OtherGREAT LAKES
MI605OtherHEALTH PLAN OF MI
MI10-2699598Medicaid
MI10-2738195Medicaid
MI006044OtherMIDWEST HEALTH PLAN
MI10-2652878Medicaid
MI0P57370OtherMEDICARE ADVANTAGE
MI10-2738195Medicaid
MI103539OtherGREAT LAKES