Mamoun Dabbagh, M.D.
Individual provider Active NPI Psychiatry Physician · Warren, MI
NPI 1962552158 · NPPES record last updated Sep 8, 2014
Key facts
- NPI
- 1962552158
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 4301045473 (MI)
- Practice address
- 28800 Ryan Rd
Ste 320
Warren, MI 48092-4272 - Phone
- (586) 582-0500
- Fax
- (586) 620-8113
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301045473 | MI | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Better Tomorrow Counseling and Consultation Services, LLC | Past | Accepting new patients | |
| Thomas Park M.D. PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301045473 | MI | Yes |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 4301045473 | MI |
Addresses
Primary practice location
28800 Ryan Rd
Ste 320
Warren, MI 48092-4272
Mailing address
28800 Ryan Rd
Ste 320
Warren, MI 48092-4272
Phone (586) 582-0500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2721634 | Medicaid | MI | |
| 2606315452 | Other | MI | BLUE CROSS BLUE SHIELD MI |
Other providers in Warren, MI
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- Isabella Denise Czygan
- D-Care PC
- D2 Dental of Michigan, P.C.
- Zeinab Dabaja
- Kimberly Ann Dacey
- Maureen L Dailey
- Nicole Melanie-Berman Dailey
- Kassem Dakdouk
- Angeline Victoria Dalal
All providers in Warren, MI · Psychiatry Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.