Healthcare Provider Details

I. General information

NPI: 1225550312
Provider Name (Legal Business Name): ABRAHAM HMEIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 FORD AVE
WYANDOTTE MI
48192-2306
US

IV. Provider business mailing address

1768 FORD AVE STE A
WYANDOTTE MI
48192-2306
US

V. Phone/Fax

Practice location:
  • Phone: 734-299-0712
  • Fax:
Mailing address:
  • Phone: 734-299-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMA059589
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5601008455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: