Provider Demographics
NPI:1336945419
Name:ABDALLAH, FATIMA (CHW)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22260 HAGGERTY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-8985
Mailing Address - Country:US
Mailing Address - Phone:313-600-1472
Mailing Address - Fax:
Practice Address - Street 1:22260 HAGGERTY RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-8985
Practice Address - Country:US
Practice Address - Phone:313-600-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker