Provider Demographics
NPI:1942493838
Name:ADAM, ABDULGADIR KHALIFA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULGADIR
Middle Name:KHALIFA
Last Name:ADAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A/GADIR
Other - Middle Name:KHALIFA
Other - Last Name:ADAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD STE 344
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-0497
Practice Address - Fax:248-551-4556
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076176207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4263Medicare PIN