Basic Information
| Provider Information | |||||||||
| NPI: | 1437355625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABU-RADDAHA | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3077 COURTZ ISLE APT 3 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107321353 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | G3499 S. LINDEN RD. SUITE 2 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107203930 | ||||||||
| FaxNumber: | 8107203970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301083497 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.