Healthcare Provider Details

I. General information

NPI: 1811820459
Provider Name (Legal Business Name): ABOBAKER MOHAMMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 ROWLAND AVE SE
GRAND RAPIDS MI
49546-5801
US

IV. Provider business mailing address

2233 ROWLAND AVE SE
GRAND RAPIDS MI
49546-5801
US

V. Phone/Fax

Practice location:
  • Phone: 906-675-9629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberP142820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: