Healthcare Provider Details

I. General information

NPI: 1396329173
Provider Name (Legal Business Name): AMR GHASSAN YOUSEF ABULABAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date: 07/15/2022
Reactivation Date: 07/09/2026

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5818
  • Fax:
Mailing address:
  • Phone: 305-243-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number174805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: