Provider Demographics
NPI:1104089499
Name:ABDULHAK, MUWAFFAK MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MUWAFFAK
Middle Name:MOHAMMAD
Last Name:ABDULHAK
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 1:2799 WEST GRAND BLVD. K-11
Mailing Address - Street 2:HENRY FORD HOSPITAL
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-2682
Mailing Address - Fax:313-916-7139
Practice Address - Street 1:2799 WEST GRAND BLVD. K-11
Practice Address - Street 2:HENRY FORD HOSPITAL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-2682
Practice Address - Fax:313-916-7139
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI381357020N174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104323153Medicaid