Basic Information
| Provider Information | |||||||||
| NPI: | 1528076619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERI | ||||||||
| FirstName: | ABDELWAHAB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 BARCLAY CIR | ||||||||
| Address2: | STE 120 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488522277 | ||||||||
| FaxNumber: | 2488522552 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 BARCLAY CIRCLE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488522277 | ||||||||
| FaxNumber: | 2488522552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301076045 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201500282 | 01 | MI | TAX ID | OTHER | 4301076045 | 01 | MI | LICENSE | OTHER | 1106346702 | 01 | MI | BLUECROSS OF MICHIGAN | OTHER | 104695604 | 05 | MI | MEDICAID |