Provider Demographics
NPI:1841960812
Name:ABD ALLAH, AMAL
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:ABD ALLAH
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 107
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1288
Mailing Address - Country:US
Mailing Address - Phone:517-505-2957
Mailing Address - Fax:
Practice Address - Street 1:1215 EAST MICHIGAN AVE
Practice Address - Street 2:SPARROW HEALTH SYSTEMS
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4891
Practice Address - Country:US
Practice Address - Phone:517-364-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351047763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics