MEDICARE: FADI ABOONA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740898592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FADI ABOONA

Provider Business Mailing Address
First Line	:	26750 PROVIDENCE PKWY
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48374-1211
Country	:	US
Telephone Number	:	866-974-2673
Fax Number	:	866-939-2673

Provider Business Practice Location Address
First Line	:	11340 HEMLOCK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-3845
Country	:	US
Telephone Number	:	586-244-7825
Fax Number	:

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	04/27/2021

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Directions to “ FADI ABOONA ” Practice Location

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