Healthcare Provider Details

I. General information

NPI: 1053870014
Provider Name (Legal Business Name): NIBAL A EID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-9000
  • Fax:
Mailing address:
  • Phone: 810-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301507036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: