Provider Demographics
NPI:1558356238
Name:ALSABBAGH, RANA (MD)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:ALSABBAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:800-845-0202
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:252
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-4411
Practice Address - Fax:313-343-4412
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067170207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4228430Medicaid
MI4228430Medicaid
F95749Medicare UPIN
M71670065Medicare ID - Type Unspecified