Healthcare Provider Details

I. General information

NPI: 1497325625
Provider Name (Legal Business Name): EHSEN ABDUL-KABIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W FRONT ST
MONROE MI
48161-2355
US

IV. Provider business mailing address

219 W FRONT ST
MONROE MI
48161-2355
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-0366
  • Fax: 734-241-0680
Mailing address:
  • Phone: 734-241-0366
  • Fax: 734-241-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301517953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: