MEDICARE: ABUNDANT LIFE CLINIC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609075662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE CLINIC

Provider Business Mailing Address
First Line	:	3800 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5004
Country	:	US
Telephone Number	:	602-340-1766
Fax Number	:	602-340-1761

Provider Business Practice Location Address
First Line	:	3800 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5004
Country	:	US
Telephone Number	:	602-340-1766
Fax Number	:	602-340-1761

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	GREGORY MUHAMMAD
Credential	:	MD
Telephone Number	:	602-340-1761

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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Directions to “ABUNDANT LIFE CLINIC ” Practice Location

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