Healthcare Provider Details

I. General information

NPI: 1952945529
Provider Name (Legal Business Name): ABBASS HAMZE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8188 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-1433
US

IV. Provider business mailing address

8188 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-1433
US

V. Phone/Fax

Practice location:
  • Phone: 313-415-2500
  • Fax: 313-454-4105
Mailing address:
  • Phone: 313-415-2500
  • Fax: 313-454-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704313441
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4704313441
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704313441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: