Provider Demographics
NPI:1831403401
Name:MAMDOUH ABDULRAZZAK MD PC
Entity type:Organization
Organization Name:MAMDOUH ABDULRAZZAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMDOUH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULRAZZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-3332
Mailing Address - Street 1:PO BOX 250341
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-0341
Mailing Address - Country:US
Mailing Address - Phone:313-563-3332
Mailing Address - Fax:313-563-3342
Practice Address - Street 1:3200 GREENFIELD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1802
Practice Address - Country:US
Practice Address - Phone:313-563-3332
Practice Address - Fax:313-563-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010630262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3232OtherMEDICARE
MIMI3231Medicare PIN