Provider Demographics
NPI:1831216753
Name:RABBANI, MAHDOKHT M (MD)
Entity type:Individual
Prefix:
First Name:MAHDOKHT
Middle Name:M
Last Name:RABBANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:586-226-6865
Mailing Address - Fax:586-226-6880
Practice Address - Street 1:20225 E 9 MILE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1775
Practice Address - Country:US
Practice Address - Phone:586-775-4711
Practice Address - Fax:586-775-4050
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010470032085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4416403Medicaid
MID90145Medicare UPIN
MIN40170037Medicare ID - Type UnspecifiedMEDICARE