Provider Demographics
NPI:1730130279
Name:HAMMOUD, MANAR ABED (MD)
Entity Type:Individual
Prefix:DR
First Name:MANAR
Middle Name:ABED
Last Name:HAMMOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:G-5119 WEST BRISTOL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-720-1510
Mailing Address - Fax:810-720-1726
Practice Address - Street 1:G5119 W BRISTOL RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-720-1510
Practice Address - Fax:810-720-1726
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4215497Medicaid
H26536Medicare UPIN
MI4215497Medicaid