Healthcare Provider Details

I. General information

NPI: 1033313028
Provider Name (Legal Business Name): ABBAS ZAGNOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMEER ABDULLH STREET KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER
JEDDAH SAUDI ARABIA
21499
SA

IV. Provider business mailing address

2998 CHAMBORD DR
WEST BLOOMFIELD MI
48323-3517
US

V. Phone/Fax

Practice location:
  • Phone: 6677777
  • Fax: 6630673
Mailing address:
  • Phone: 248-538-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301060783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: