Provider Demographics
NPI:1386132728
Name:OBEID, ABDLLQWY (MD)
Entity type:Individual
Prefix:DR
First Name:ABDLLQWY
Middle Name:
Last Name:OBEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3611 CARPENTER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2784
Mailing Address - Country:US
Mailing Address - Phone:313-733-8286
Mailing Address - Fax:313-343-8747
Practice Address - Street 1:3611 CARPENTER ST STE 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2784
Practice Address - Country:US
Practice Address - Phone:313-733-8286
Practice Address - Fax:313-826-0899
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301503857207R00000X
MI4301114571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386132728Medicaid