Provider Demographics
NPI:1962673350
Name:MAMOUN DABBAGH, M.D., PLLC
Entity Type:Organization
Organization Name:MAMOUN DABBAGH, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:DABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-371-2202
Mailing Address - Street 1:1525 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2673
Mailing Address - Country:US
Mailing Address - Phone:248-371-2202
Mailing Address - Fax:
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2673
Practice Address - Country:US
Practice Address - Phone:248-371-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB48716Medicare UPIN