Provider Demographics
NPI:1316155864
Name:ABDULHAK, MUNZER (MD)
Entity type:Individual
Prefix:DR
First Name:MUNZER
Middle Name:
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 1:6505 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1604
Mailing Address - Country:US
Mailing Address - Phone:369-343-0377
Mailing Address - Fax:269-343-4744
Practice Address - Street 1:6505 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1604
Practice Address - Country:US
Practice Address - Phone:369-343-0377
Practice Address - Fax:269-343-4744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23493207W00000X
VA0101244950207W00000X
NC2009-01191207W00000X
LAMD.203172207W00000X
MI4301095618207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316155864Medicaid
WV3810016135Medicaid
WVPTAN: 4275541Medicare PIN
MI6356840001Medicare NSC
MIMI3020001Medicare PIN
VAPTAN: C10848Medicare PIN