MEDICARE: MAHA MORTADA ABDALLAH MS, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1093531790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHA MORTADA ABDALLAH MS, RDN

Provider Business Mailing Address
First Line	:	1871 TALL PINES DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7924
Country	:	US
Telephone Number	:	313-454-6487
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 HEADLEY ST SE UNIT 142
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-4504
Country	:	US
Telephone Number	:	313-454-6487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	03/25/2026

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