Healthcare Provider Details

I. General information

NPI: 1265114938
Provider Name (Legal Business Name): MOHANNAD YOUSEF ABUSALEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DRIVE D5252MPB, SPC5718
ANN ARBOR MI
48109-5718
US

IV. Provider business mailing address

1500 EAST MEDICAL CENTER DRIVE D5252MPB, SPC5718
ANN ARBOR MI
48109-5718
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4717
  • Fax:
Mailing address:
  • Phone: 734-936-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301516352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: