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General NPI Number Information
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NPI Number | 1154918282
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Entity Type | Individual
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Provider Name | ABDULSALAM ALKADHY
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Gender | Male
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 687 UNIVERSITY DR
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City | PONTIAC
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State | MI
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Zip | 48342-1758
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Country | US
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Telephone | 313-888-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 FERNEY ST # 1
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City | DEARBORN
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State | MI
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Zip | 48120-1711
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Country | US
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Telephone | 313-888-2212
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 5351016498
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License Number State | MI
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