Provider Demographics
NPI:1831291509
Name:ABDULRAZZAK, ABDULKADER (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULKADER
Middle Name:
Last Name:ABDULRAZZAK
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 1:1513 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1728
Mailing Address - Country:US
Mailing Address - Phone:810-744-0660
Mailing Address - Fax:
Practice Address - Street 1:1513 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1728
Practice Address - Country:US
Practice Address - Phone:810-744-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235860Medicaid
MI3235860Medicaid
MIB47211Medicare UPIN