Basic Information
| Provider Information | |||||||||
| NPI: | 1578767950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDULMALIK | ||||||||
| FirstName: | AMEEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15150 FORT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481951302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342824800 | ||||||||
| FaxNumber: | 7342829302 | ||||||||
| Practice Location | |||||||||
| Address1: | 15150 FORT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481951302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342824800 | ||||||||
| FaxNumber: | 7342829302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 4301078156 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 4301078156 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 11783199 | 01 | MI | CAQH | OTHER | 4301078156 | 01 | MI | STATE LICENSE # | OTHER | AA078156 | 01 | MI | MI STATE MEDICAL LICENSE | OTHER | 1578767950 | 01 | MI | BCBS TYPE 1 NPI | OTHER | 1578767950 | 05 | MI | MEDICAID |