Healthcare Provider Details

I. General information

NPI: 1902123904
Provider Name (Legal Business Name): NINUL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E BIG BEAVER RD
TROY MI
48083-1423
US

IV. Provider business mailing address

23679 CALABASAS RD STE 784
CALABASAS CA
91302-1502
US

V. Phone/Fax

Practice location:
  • Phone: 248-525-5314
  • Fax: 877-353-2634
Mailing address:
  • Phone: 248-525-5314
  • Fax: 877-353-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR ABIRAGI
Title or Position: FAMILY PRACTICE/PLASTIC SURGERY
Credential: M.D.,
Phone: 248-525-5314