=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578767950
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMEEN ABDULMALIK M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2007
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 465 N TELEGRAPH RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48162-3334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-242-8880
-----------------------------------------------------
Fax | 734-384-0139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15150 FORT ST
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-282-4800
-----------------------------------------------------
Fax | 734-282-9302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 4301078156
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 4301078156
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------