Healthcare Provider Details

I. General information

NPI: 1942146691
Provider Name (Legal Business Name): IBRAHIM ABDUL HADI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD STE 102
WARREN MI
48093-3487
US

IV. Provider business mailing address

11900 E 12 MILE RD STE 102
WARREN MI
48093-3487
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-7470
  • Fax: 586-573-0850
Mailing address:
  • Phone: 586-573-7470
  • Fax: 586-573-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: