Omar Abdelrahman, DDS
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Detroit, MI
NPI 1053937086 · NPPES record last updated Aug 1, 2021
Key facts
- NPI
- 1053937086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 2901601045 (MI)
- Practice address
- 4201 Saint Antoine St RM 2D
Detroit, MI 48201-2153 - Phone
- (313) 745-4266
- NPI assigned
- Jun 25, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200708002420 | MI | Order and Referring Only - Oral Surgery |
6709209828 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 2901601045 | MI | Yes |
Addresses
Primary practice location
4201 Saint Antoine St RM 2D
Detroit, MI 48201-2153
Mailing address
4201 Saint Antoine St
Detroit, MI 48201-2153
Phone (313) 745-4697
Other providers in Detroit, MI
- Omar Sami Abdelhai
- Tasneem Mahmoud Abdelhamid
- Ahmed Reda Muhammed Abdelkader
- Jamal Abdellateef
- Ahmed Khaled Abdelaziz Abdelrahman
- Fabiha Abdin
- Abdllqwy Obeid MD PLLC
- Jaber Ali Abdo
- Maher K. Abdo
- Shaheed Abdo
All providers in Detroit, MI · Student in an Organized Health Care Education/Training Program in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.