Healthcare Provider Details

I. General information

NPI: 1215380456
Provider Name (Legal Business Name): BASIL ABDO MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24224 JOY RD SUITE 100
REDFORD MI
48239-1215
US

IV. Provider business mailing address

24224 JOY RD SUITE 100
REDFORD MI
48239-1215
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-9090
  • Fax: 313-561-3646
Mailing address:
  • Phone: 313-561-9090
  • Fax: 313-561-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301081899
License Number StateMI

VIII. Authorized Official

Name: BASIL ABDO
Title or Position: OWNER
Credential: M.D.
Phone: 313-561-9090