Provider Demographics
NPI:1265503031
Name:SHAMSUDDOHA, ABUL (MD)
Entity type:Individual
Prefix:DR
First Name:ABUL
Middle Name:
Last Name:SHAMSUDDOHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1871
Mailing Address - Country:US
Mailing Address - Phone:248-652-9450
Mailing Address - Fax:248-652-1095
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:STE 103
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5053
Practice Address - Country:US
Practice Address - Phone:248-652-9450
Practice Address - Fax:248-920-0641
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-04-06
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Provider Licenses
StateLicense IDTaxonomies
MI4301037481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102116838Medicaid
110007235OtherMEDICARE RAILROAD
38237496OtherBCBS
B44394OtherHEALTH ALLIANCE PLAN
1228330002OtherWELLNESS PLAN
229772OtherOMNICARE
103422OtherPREFERRED CHOICES
B44394OtherHEALTH ALLIANCE PLAN
1228330002OtherWELLNESS PLAN