Provider Demographics
NPI:1740776574
Name:ABDELGADIR, AYAT KHIDIR
Entity type:Individual
Prefix:
First Name:AYAT
Middle Name:KHIDIR
Last Name:ABDELGADIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N CEDAR ST APT 212
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1289
Mailing Address - Country:US
Mailing Address - Phone:571-645-0320
Mailing Address - Fax:
Practice Address - Street 1:788 SERVICE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7013
Practice Address - Country:US
Practice Address - Phone:517-432-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301115099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine