Provider Demographics
NPI:1457382939
Name:ABDELJABER, MUTEE HUSEIN (MD)
Entity Type:Individual
Prefix:
First Name:MUTEE
Middle Name:HUSEIN
Last Name:ABDELJABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:634 N STATE ST
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-0330
Mailing Address - Country:US
Mailing Address - Phone:989-672-0092
Mailing Address - Fax:989-672-0093
Practice Address - Street 1:634 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1544
Practice Address - Country:US
Practice Address - Phone:989-672-0092
Practice Address - Fax:989-672-0093
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054597207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI316227210Medicaid
MI07645922352Medicare ID - Type Unspecified
F25001Medicare UPIN