Provider Demographics
NPI:1144055286
Name:ABUELHAWA, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ABUELHAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1974
Mailing Address - Country:US
Mailing Address - Phone:313-552-6630
Mailing Address - Fax:
Practice Address - Street 1:2100 KINLOCH ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3318
Practice Address - Country:US
Practice Address - Phone:313-552-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician