Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301106734 | MI |
Y | 2080P0216X | Pediatric Rheumatologist | 4301106734 | MI |
NPI | 1033379458 |
---|---|
Provider Name | Khalid Mohammed Abulaban |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 19/02/2021 |