NPIMap

Individual provider Active NPI

Mamdouh Abdulrazzak, M.D.

  • Neurology Physician
  • Dearborn, MI
National Provider Identifier
1689649923
Registry record updated Apr 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MA0163026 Issued in MI
Practice address
4700 Greenfield Rd
Dearborn, MI 48126-4124
Phone
(313) 945-6100
Fax
(313) 945-5260
NPI assigned
Feb 21, 2006
Last updated
Apr 29, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MA0163026 MI Primary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 4301063026 MI

Addresses

Primary practice location

4700 Greenfield Rd
Dearborn, MI 48126-4124

Mailing address

4700 Greenfield Rd
Dearborn, MI 48126-4124
Phone (313) 563-3332

Other identifiers 2

IdentifierTypeStateIssuer
5209224MedicaidMI
4272199MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070406000251 MI Practitioner - NeurologyPractitioner - Sleep Medicine 2668576349 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Sleep Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Physicians of Dearborn PLLCGroup PAC ID 5698667194, 4 clinicians

Practice addresses (Care Compare)

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 593-7000

4700 Greenfield Rd
Dearborn, MI 48126-4124
Phone (313) 945-6100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA0163026MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Healthcare Inc CurrentSince Mar 16, 2015 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 1, 2017 Accepting new patients
Oakwood Healthcare, Inc. Current Accepting new patients
Bronson Methodist Hospital Sleep Medicine CurrentSince Mar 26, 2018 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 1, 2017 Accepting new patients
Mamdouh Abdulrazzak MD PC Neurology CurrentSince Aug 1, 2010 Accepting new patients
Oakwood Healthcare, Inc CurrentSince Mar 16, 2015 Accepting new patients
Albert C. Lee, M.D., P.C. Neurology PastSince Mar 20, 1997 Accepting new patients
Mid Michigan Diagnostic Corp Past Accepting new patients
Mid Michigan Diagnostic Corp Sleep Medicine PastSince Jun 1, 2012 Accepting new patients

Locations

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

4700 Greenfield Rd
Dearborn, MI 48126
Phone (313) 624-9470

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

4600 Breton Rd SE
Ste 102
Kentwood, MI 49508
Phone (616) 356-4161

1075 Suncrest Dr
Ste C
Lapeer, MI 48446
Phone (810) 667-7333

1083 Suncrest Dr
Lapeer, MI 48446
Phone (810) 245-3446

2111 12 Mile Rd NW
Sparta, MI 49345
Phone (616) 391-8470

10000 Telegraph Rd
Taylor, MI 48180
Phone (313) 295-5000

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1689649923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 GREENFIELD RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264124",
            "telephone_number": "313-563-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 GREENFIELD RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264124",
            "telephone_number": "313-945-6100",
            "fax_number": "313-945-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULRAZZAK",
        "first_name": "MAMDOUH",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "MA0163026",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "4301063026",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5209224",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4272199",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.