Healthcare Provider Details

I. General information

NPI: 1053332296
Provider Name (Legal Business Name): HUSAM ABED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15265 NORTHLINE RD
SOUTHGATE MI
48195-2487
US

IV. Provider business mailing address

12025 INA DR UNIT 98
STERLING HEIGHTS MI
48312-5055
US

V. Phone/Fax

Practice location:
  • Phone: 734-589-2166
  • Fax:
Mailing address:
  • Phone: 248-635-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number4301075802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: