Provider Demographics
NPI:1629023254
Name:ABDALLA, RAMEZ (MD)
Entity Type:Individual
Prefix:
First Name:RAMEZ
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 DYEMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2316
Mailing Address - Country:US
Mailing Address - Phone:810-733-7064
Mailing Address - Fax:
Practice Address - Street 1:1133 DYEMEADOW LN
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2316
Practice Address - Country:US
Practice Address - Phone:810-733-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4280501Medicaid
MIG19810Medicare UPIN
MI4280501Medicaid