Healthcare Provider Details

I. General information

NPI: 1861362683
Provider Name (Legal Business Name): ABDULRAHMAN SUBHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 E 14 MILE RD
STERLING HEIGHTS MI
48312-6153
US

IV. Provider business mailing address

3052 N MITCHELL ST
BOISE ID
83704-5571
US

V. Phone/Fax

Practice location:
  • Phone: 208-513-0699
  • Fax:
Mailing address:
  • Phone: 208-513-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: