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General NPI Number Information
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NPI Number | 1497205546
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Entity Type | Organization
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Legal Business Name | CAPITOL INFECTIOUS DISEASE ASSOCIATES
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 6401 PINE HOLLOW DR
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City | EAST LANSING
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State | MI
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Zip | 48823-9737
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Country | US
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Telephone | 517-339-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 PINE HOLLOW DR STE 400
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City | EAST LANSING
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State | MI
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Zip | 48823-9224
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Country | US
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Telephone | 517-339-1676
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Fax |
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Authorized Official
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Title or Position | OWNER / AUTHORIZED OFFICIAL
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Name | MUJAHED ABBAS
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Credential | MD
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Telephone | 517-339-1676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 4301054596
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License Number State | MI
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