Aishah Gabbar
Individual provider Active NPI Primary Care Nurse Practitioner · Melvindale, MI
NPI 1992683304 · NPPES record last updated Aug 25, 2025
Key facts
- NPI
- 1992683304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 4704349955 (MI)
- Practice address
- 17169 Eddon St
Melvindale, MI 48122-1221 - Phone
- (313) 445-3482
- NPI assigned
- Aug 25, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- My Clinic PLLC
Practice addresses (Care Compare)
4025 Maple St
Suite B
Dearborn, MI 48126-3532
Phone (313) 269-4184
Hospital & facility affiliations
- Beaumont Hospital - Dearborn
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: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251223001373 | MI | Practitioner - Nurse Practitioner | 9436644887 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704349955 | MI | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Clinic PLLC | Current |
Accepting new patients |
Locations
4025 Maple St
Ste B
Dearborn, MI 48126
Phone (313) 269-4184
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 4704349955 | MI | Yes |
Addresses
Primary practice location
17169 Eddon St
Melvindale, MI 48122-1221
Mailing address
17169 Eddon St
Melvindale, MI 48122-1221
Phone (313) 445-3482
Other providers in Melvindale, MI
- Dimensions of Wellness, Inc., a Nonprofit Corporation
- Katie Drake
- Ali Rashid Elhasan
- Farooq Sons LLC
- Hisham Fittahy
- Gog Pharmacy PLLC
- Tina M Gomez
- Great Lakes Medical Transit LLC
- Madison Hassa
- Jessica Hayes
All providers in Melvindale, MI · Primary Care Nurse Practitioner 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 25, 2025. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.