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General NPI Number Information
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NPI Number | 1104353077
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Entity Type | Individual
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Provider Name | RYAN ABBOUD DO
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 32270 TELEGRAPH RD STE 240
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2457
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Country | US
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Telephone | 248-548-3060
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Fax | 248-548-3078
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Provider Business Mailing Address
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Address Line | 18207 GOULD CT
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5451
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Country | US
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Telephone | 248-219-3762
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101025222
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License Number State | MI
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