Provider Demographics
NPI:1053984989
Name:ABU-SAMAK, ABDEL-AZEZ OMAR ABDEL AZIZ (MBBS)
Entity type:Individual
Prefix:
First Name:ABDEL-AZEZ
Middle Name:OMAR ABDEL AZIZ
Last Name:ABU-SAMAK
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W GRAND BLVD FL 6
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2610
Mailing Address - Country:US
Mailing Address - Phone:908-737-2573
Mailing Address - Fax:
Practice Address - Street 1:2800 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2610
Practice Address - Country:US
Practice Address - Phone:888-777-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program