Provider Demographics
NPI:1649441593
Name:ABUL H M SHAMSUDDOHA
Entity type:Organization
Organization Name:ABUL H M SHAMSUDDOHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSUDDOHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-652-9450
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-652-9450
Mailing Address - Fax:248-652-1095
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-652-9450
Practice Address - Fax:248-652-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037481207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty