Provider Demographics
NPI:1922116128
Name:NABIL METWALLY MD PC
Entity Type:Organization
Organization Name:NABIL METWALLY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:METWALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-565-6663
Mailing Address - Street 1:39353 HEATHERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2918
Mailing Address - Country:US
Mailing Address - Phone:313-565-6663
Mailing Address - Fax:313-565-6632
Practice Address - Street 1:24224 JOY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1215
Practice Address - Country:US
Practice Address - Phone:313-565-6663
Practice Address - Fax:313-565-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064169207R00000X
363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922116128Medicaid
MI0P38590Medicare PIN
MI1922116128Medicaid
MI4088518Medicaid
MI4329694Medicaid
MI0P38590Medicare PIN
MINM064169OtherBC/BS