Healthcare Provider Details

I. General information

NPI: 1235165275
Provider Name (Legal Business Name): MADAR ABED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 W PIERSON RD UNIT 1
FLUSHING MI
48433-3104
US

IV. Provider business mailing address

6122 W PIERSON RD UNIT 1
FLUSHING MI
48433-3104
US

V. Phone/Fax

Practice location:
  • Phone: 810-600-3399
  • Fax: 810-600-3398
Mailing address:
  • Phone: 810-600-3399
  • Fax: 810-600-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00041901
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD24304
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301067788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: