Provider Demographics
NPI:1942381728
Name:SHAMSUDDIN, ABUL K (MD)
Entity type:Individual
Prefix:DR
First Name:ABUL
Middle Name:K
Last Name:SHAMSUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19727 ALLEN RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1188
Mailing Address - Country:US
Mailing Address - Phone:734-479-8000
Mailing Address - Fax:734-479-4812
Practice Address - Street 1:19727 ALLEN RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1188
Practice Address - Country:US
Practice Address - Phone:734-479-8000
Practice Address - Fax:734-479-4812
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034521207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
380000714OtherMEDICARE RAILROAD
MI102103689Medicaid
MI1108242551OtherBCBSM
NC005768OtherM-CARE
MI102103689Medicaid
380000714OtherMEDICARE RAILROAD