Basic Information
Provider Information | |||||||||
NPI: | 1689830192 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ADEL | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: | GHASSAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4677 TOWNE CENTRE RD | ||||||||
Address2: | SUITE 301 | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486042846 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552989888 | ||||||||
FaxNumber: | 9894973128 | ||||||||
Practice Location | |||||||||
Address1: | 4677 TOWNE CENTRE RD | ||||||||
Address2: | SUITE 301 | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486042846 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552989888 | ||||||||
FaxNumber: | 9894973128 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/04/2008 | ||||||||
LastUpdateDate: | 04/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 125051383 | IL | N |   | Other Service Providers | Specialist |   | 207T00000X | 4301106211 | MI | Y |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 125051383 | 01 | IL | STATE LICENSE NUMBER | OTHER | 4301106211 | 01 | MI | MI LICENSE | OTHER |