Provider Demographics
NPI:1750956652
Name:EL-MALLAH, ABDAL-RAHMAN IBRAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:ABDAL-RAHMAN
Middle Name:IBRAHIM
Last Name:EL-MALLAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:ABD AL RAHMAN
Other - Middle Name:IBRAHIM
Other - Last Name:EL-MALLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12700 S MORROW CIR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1552
Mailing Address - Country:US
Mailing Address - Phone:313-623-4910
Mailing Address - Fax:
Practice Address - Street 1:12700 S MORROW CIR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1552
Practice Address - Country:US
Practice Address - Phone:313-623-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351048550207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program