Provider Demographics
NPI:1447919634
Name:ABDALLA, ASHRAF FAROUK MOHAMED I (MT)
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:FAROUK MOHAMED I
Last Name:ABDALLA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 NW 22ND CT APT 118
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3403
Mailing Address - Country:US
Mailing Address - Phone:773-332-7761
Mailing Address - Fax:
Practice Address - Street 1:4750 NW 22ND CT APT 118
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-3403
Practice Address - Country:US
Practice Address - Phone:773-332-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU51615291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory