Healthcare Provider Details

I. General information

NPI: 1700520632
Provider Name (Legal Business Name): ABDULLAH A ADIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DRIVE, SPC 5312 TAUBMAN CENTER, 1ST FLOOR, ROOM 1903
ANN ARBOR MI
48109
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DRIVE, SPC 5312 TAUBMAN CENTER, 1ST FLOOR, ROOM 1903
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-736-9178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351049120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: