Provider Demographics
NPI:1679099899
Name:AWADELKARIM, ABDALAZIZ MOHAMED ALI (MBBS)
Entity Type:Individual
Prefix:
First Name:ABDALAZIZ
Middle Name:MOHAMED ALI
Last Name:AWADELKARIM
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:ABDALAZIZ MOHAMED
Other - Middle Name:
Other - Last Name:AWADELKARIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:UNIVERSITY OF KHARTOUM FACULTY OF MEDICINE
Mailing Address - Street 2:ELQASAR STREER
Mailing Address - City:KHARTOUM
Mailing Address - State:SUDAN
Mailing Address - Zip Code:00100
Mailing Address - Country:SD
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST # 9C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0465208600000X
MI4351047163APP20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery