Provider Demographics
NPI:1851314256
Name:AHMAD AL DABAGH, M.D., P.C.
Entity Type:Organization
Organization Name:AHMAD AL DABAGH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL DABAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-8105
Mailing Address - Street 1:5084 VILLA LINDE PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3422
Mailing Address - Country:US
Mailing Address - Phone:810-733-8105
Mailing Address - Fax:810-733-8135
Practice Address - Street 1:5084 VILLA LINDE PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3422
Practice Address - Country:US
Practice Address - Phone:810-733-8105
Practice Address - Fax:810-733-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102504361OtherBLUE CROSS BLUE SHIELD
MI4301746Medicaid
MI1102504361OtherBLUE CROSS BLUE SHIELD
MI4301746Medicaid