Active NPI
Tumodir Atta Abdallah, MD
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1053107516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 6071 W. Outer Drive
Detroit, MI 48235 - Phone
- (313) 966-3250
- NPI assigned
- Apr 19, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
6071 W. Outer Drive
Detroit, MI 48235
Mailing address
14508 S Stirrup CT
Homer Glen, IL 60491-9297
Phone (708) 401-3804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250611003026 | MI | Order and Referring Only - Internal Medicine | 2961912597 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745193600000",
"number": "1053107516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14508 S STIRRUP CT",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604919297",
"telephone_number": "708-401-3804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6071 W. OUTER DRIVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "48235",
"telephone_number": "313-966-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABDALLAH",
"first_name": "TUMODIR",
"middle_name": "ATTA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-19",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.