Healthcare Provider Details

I. General information

NPI: 1316280738
Provider Name (Legal Business Name): MURTADHA ABDULHUSSEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3000
  • Fax:
Mailing address:
  • Phone: 313-745-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number4301103526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: