Healthcare Provider Details

I. General information

NPI: 1801450077
Provider Name (Legal Business Name): HUYAM AWADALLA HASSAN AWADALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MACK AVE
DETROIT MI
48201-2136
US

IV. Provider business mailing address

4201 ST. ANTOINE, UHC 9C -DMC-GME OFFICE
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-448-9650
  • Fax:
Mailing address:
  • Phone: 313-966-0463
  • 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 Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301511689
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: