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General NPI Number Information
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NPI Number | 1205807260
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Entity Type | Individual
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Provider Name | IHAB MOHAMMED DEEBAJAH MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 6255 INKSTER RD SUITE 204
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City | GARDEN CITY
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State | MI
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Zip | 48135-2577
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Country | US
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Telephone | 734-524-0950
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Fax | 734-524-0951
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Provider Business Mailing Address
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Address Line | 1110 N TELEGRAPH RD
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City | DEARBORN
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State | MI
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Zip | 48128-1203
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Country | US
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Telephone | 313-294-5400
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Fax | 313-294-5401
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4301067420
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License Number State | MI
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