Healthcare Provider Details

I. General information

NPI: 1225087414
Provider Name (Legal Business Name): ABD A ALGHANEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 CHARTER DR SUITE B
FLINT MI
48532-3584
US

IV. Provider business mailing address

1020 CHARTER DR SUITE B
FLINT MI
48532-3584
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-8300
  • Fax: 810-733-8313
Mailing address:
  • Phone: 810-733-8300
  • Fax: 810-733-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberAA044114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: