Provider Demographics
NPI:1063054625
Name:ABOU-TAAM, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:ABOU-TAAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2021
Mailing Address - Country:US
Mailing Address - Phone:313-433-2390
Mailing Address - Fax:
Practice Address - Street 1:4020 VENOY RD STE 900A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1869
Practice Address - Country:US
Practice Address - Phone:734-729-2882
Practice Address - Fax:734-729-6546
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist