Healthcare Provider Details

I. General information

NPI: 1902745870
Provider Name (Legal Business Name): ABDUL RAHAMAN FOGGIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 STECKER ST
DEARBORN MI
48126-3813
US

IV. Provider business mailing address

19527 MAHON ST
SOUTHFIELD MI
48075-3939
US

V. Phone/Fax

Practice location:
  • Phone: 313-396-5300
  • Fax:
Mailing address:
  • Phone: 313-396-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: