Provider Demographics
NPI:1760797344
Name:ABDALLA, MOHAMED ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ALI
Last Name:ABDALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2387 S LINDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5443
Mailing Address - Country:US
Mailing Address - Phone:810-733-1700
Mailing Address - Fax:810-733-1701
Practice Address - Street 1:2387 S LINDEN RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5443
Practice Address - Country:US
Practice Address - Phone:810-733-1700
Practice Address - Fax:810-733-1701
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113055207RN0300X
OH1053353896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084750Medicaid
OHH199800Medicare PIN