Healthcare Provider Details

I. General information

NPI: 1831769801
Provider Name (Legal Business Name): DR. ABDULAZIZ AL-ABDULGHANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

2505 SHOWTIME DR APT 511
LANSING MI
48912-5644
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 517-219-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4351047424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: