Healthcare Provider Details

I. General information

NPI: 1437000817
Provider Name (Legal Business Name): DR. AHMAD ABU BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49959 CHERRY HILL RD
CANTON MI
48188-2972
US

IV. Provider business mailing address

22341 W 8 MILE RD STE 200
DETROIT MI
48219-1217
US

V. Phone/Fax

Practice location:
  • Phone: 734-789-4997
  • Fax:
Mailing address:
  • Phone: 313-371-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: