Provider Demographics
NPI:1912873530
Name:IBDAH, HIND
Entity type:Individual
Prefix:
First Name:HIND
Middle Name:
Last Name:IBDAH
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 1:627 S WEBIK AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2602
Mailing Address - Country:US
Mailing Address - Phone:628-888-9950
Mailing Address - Fax:
Practice Address - Street 1:627 S WEBIK AVE
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2602
Practice Address - Country:US
Practice Address - Phone:628-888-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1213598115Medicaid