Provider Demographics
NPI:1447230941
Name:ABDALLAH, BELAL FOUAD (MD)
Entity type:Individual
Prefix:DR
First Name:BELAL
Middle Name:FOUAD
Last Name:ABDALLAH
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 1:15400 MICHIGAN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3491
Mailing Address - Country:US
Mailing Address - Phone:313-584-3359
Mailing Address - Fax:313-584-1729
Practice Address - Street 1:15400 MICHIGAN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3491
Practice Address - Country:US
Practice Address - Phone:313-584-3359
Practice Address - Fax:313-584-1729
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBA059825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11OH218060OtherBCBS
MI3192530Medicaid
MIG16950OtherHAP
MAC5070OtherMCARE
MIP00195891OtherMEDICARE RAILROAD
MI3192530Medicaid
MION16040Medicare ID - Type Unspecified