Healthcare Provider Details

I. General information

NPI: 1003436957
Provider Name (Legal Business Name): HUSSEIN NOUREDDINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15411 SOUTHFIELD RD
ALLEN PARK MI
48101-2681
US

IV. Provider business mailing address

7840 KENTUCKY ST
DEARBORN MI
48126-1210
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-8604
  • Fax:
Mailing address:
  • Phone: 313-587-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: