Provider Demographics
NPI:1972708105
Name:TAL, ABDEL KADER (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDEL KADER
Middle Name:
Last Name:TAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDEL KADER
Other - Middle Name:
Other - Last Name:EL TAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 W SOUTH BOUNDARY ST BLDG 9A
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5245
Mailing Address - Country:US
Mailing Address - Phone:419-873-6963
Mailing Address - Fax:419-873-6964
Practice Address - Street 1:900 W SOUTH BOUNDARY ST BLDG 9A
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5245
Practice Address - Country:US
Practice Address - Phone:419-873-6963
Practice Address - Fax:419-873-6964
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089516207N00000X, 207ND0900X, 207NS0135X
OH35124449207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.124449OtherSTATE LICENSE NUMBER