Provider Demographics
NPI:1841394467
Name:OB GYN ASSOCIATES PLLC
Entity Type:Organization
Organization Name:OB GYN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSHTAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-2230
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-288-2230
Mailing Address - Fax:248-288-5450
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2230
Practice Address - Fax:248-288-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI06333108161Medicare ID - Type Unspecified
MIB48898Medicare UPIN