Provider Demographics
NPI:1528076619
Name:MERI, ABDELWAHAB (MD)
Entity type:Individual
Prefix:DR
First Name:ABDELWAHAB
Middle Name:
Last Name:MERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:STE 120
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5803
Mailing Address - Country:US
Mailing Address - Phone:248-852-2277
Mailing Address - Fax:248-852-2552
Practice Address - Street 1:135 BARCLAY CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-852-2277
Practice Address - Fax:248-852-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201500282OtherTAX ID
MI4301076045OtherLICENSE
MI1106346702OtherBLUECROSS OF MICHIGAN
MI104695604Medicaid
MIP00430001Medicare ID - Type Unspecified
MI4301076045OtherLICENSE