Provider Demographics
NPI:1578855847
Name:ADNAN, ABDULLAH (DO)
Entity Type:Individual
Prefix:MR
First Name:ABDULLAH
Middle Name:
Last Name:ADNAN
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 1:1201 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1852
Mailing Address - Country:US
Mailing Address - Phone:847-962-1386
Mailing Address - Fax:517-205-7525
Practice Address - Street 1:1201 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1852
Practice Address - Country:US
Practice Address - Phone:847-962-1386
Practice Address - Fax:517-205-7525
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING208100000X
MI5101021514208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation