Basic Information
Provider Information | |||||||||
NPI: | 1194876409 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JABBAR | ||||||||
FirstName: | MUHAMMAD | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1085 S LINDEN RD | ||||||||
Address2: | SUITE 150 | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 485323421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8102629773 | ||||||||
FaxNumber: | 8102626207 | ||||||||
Practice Location | |||||||||
Address1: | 806 TUURI PL | ||||||||
Address2: | HURLEY CHILDRENS CLINIC | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 485032465 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8102579773 | ||||||||
FaxNumber: | 8107627030 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/15/2007 | ||||||||
LastUpdateDate: | 05/02/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 4301060671 | MI | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
ID | Type | State | Issuer | Description | 2878427 | 05 | MI |   | MEDICAID |