Healthcare Provider Details

I. General information

NPI: 1902428832
Provider Name (Legal Business Name): MUHANAD ABOU TOUK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date: 01/17/2022
Reactivation Date: 02/22/2022

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

4201 ST, ANTOINE, DETROIT MEDICAL CENTER, GME OFFICE UHC-9C
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-4400
  • Fax:
Mailing address:
  • Phone: 313-745-5146
  • Fax: 313-966-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036165333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: