Provider Demographics
NPI:1831291764
Name:AL JABBAN, MOHAMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:AL JABBAN
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 1:5232 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2182
Mailing Address - Country:US
Mailing Address - Phone:810-736-0970
Mailing Address - Fax:810-736-3241
Practice Address - Street 1:5232 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2161
Practice Address - Country:US
Practice Address - Phone:810-736-0970
Practice Address - Fax:810-736-3241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF13211Medicare UPIN
MIM23560003Medicare PIN
MIM23560003Medicare PIN