Healthcare Provider Details

I. General information

NPI: 1609642156
Provider Name (Legal Business Name): ANNABELLA RABBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 ORCHARD LAKE RD STE 120
WEST BLOOMFIELD MI
48322-2398
US

IV. Provider business mailing address

259 MACK AVE
DETROIT MI
48201-2427
US

V. Phone/Fax

Practice location:
  • Phone: 248-462-6045
  • Fax: 248-855-6213
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: