Provider Demographics
NPI:1902428832
Name:ABOU TOUK, MUHANAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHANAD
Middle Name:
Last Name:ABOU TOUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST, ANTOINE, DETROIT MEDICAL CENTER, GME OFFICE
Mailing Address - Street 2:UHC-9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:1401 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2315
Practice Address - Country:US
Practice Address - Phone:779-696-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-08-24
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-22
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036165333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program