Healthcare Provider Details

I. General information

NPI: 1740695048
Provider Name (Legal Business Name): YUSRA ABIDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 W BIG BEAVER RD
TROY MI
48084-2901
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-816-2558
  • Fax:
Mailing address:
  • Phone: 248-551-2040
  • Fax: 248-898-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301106109
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: