Healthcare Provider Details

I. General information

NPI: 1194309914
Provider Name (Legal Business Name): RASHA MOHAMMED ABDULRIDHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST # 7A
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST # 7A
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 248-822-9801
  • Fax: 313-966-8111
Mailing address:
  • Phone: 313-822-9801
  • Fax: 313-966-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301510188
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301510188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: