Healthcare Provider Details

I. General information

NPI: 1528418761
Provider Name (Legal Business Name): AMJAD ABDALLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE STE 4297
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

275 MICHIGAN ST NE FL 10
GRAND RAPIDS MI
49503-2531
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7900
  • Fax:
Mailing address:
  • Phone: 616-267-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number4301501236
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301501236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: