Provider Demographics
NPI:1972167526
Name:ABBAS, ALI HASSAN (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:HASSAN
Last Name:ABBAS
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 1:44405 WOODWARD AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-858-6233
Mailing Address - Fax:248-858-3244
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-6233
Practice Address - Fax:248-858-3244
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2024-01-04
Deactivation Date:2019-12-16
Deactivation Code:
Reactivation Date:2021-10-04
Provider Licenses
StateLicense IDTaxonomies
MEMD26050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine