Provider Demographics
NPI:1093531790
Name:ABDALLAH, MAHA MORTADA (MS, RDN)
Entity type:Individual
Prefix:
First Name:MAHA
Middle Name:MORTADA
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 TALL PINES DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7924
Mailing Address - Country:US
Mailing Address - Phone:313-454-6487
Mailing Address - Fax:
Practice Address - Street 1:5557 28TH ST SE STE B165
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2025
Practice Address - Country:US
Practice Address - Phone:313-454-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered