Provider Demographics
NPI:1891960191
Name:WALID ABUHAMMOUR MD
Entity Type:Organization
Organization Name:WALID ABUHAMMOUR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABUHAMMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-233-7103
Mailing Address - Street 1:PO BOX 7862
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-0862
Mailing Address - Country:US
Mailing Address - Phone:810-233-7103
Mailing Address - Fax:810-233-9710
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-233-7103
Practice Address - Fax:810-233-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104472832Medicaid