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General NPI Number Information
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NPI Number | 1043565500
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Entity Type | Individual
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Provider Name | ABDULLAH MALKAWI M.D
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Gender | Male
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-5174
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SAINT ANTOINE ST
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-5416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301101132
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD15785
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License Number State | RI
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