Provider Demographics
NPI:1063408482
Name:KATRANJI, ABDALRAHMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ABDALRAHMAN
Middle Name:
Last Name:KATRANJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5674
Mailing Address - Country:US
Mailing Address - Phone:313-292-0730
Mailing Address - Fax:313-292-1626
Practice Address - Street 1:7700 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2236
Practice Address - Country:US
Practice Address - Phone:313-292-0730
Practice Address - Fax:313-292-1626
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037674207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2097723Medicaid
MIA74166Medicare UPIN
MI2097723Medicaid