Provider Demographics
NPI:1861514135
Name:ABU MUHANNA, AMJED YOUSEF (MD)
Entity type:Individual
Prefix:
First Name:AMJED
Middle Name:YOUSEF
Last Name:ABU MUHANNA
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:PO BOX 18
Mailing Address - Street 2:3130 SHORE DR
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0018
Mailing Address - Country:US
Mailing Address - Phone:715-735-7421
Mailing Address - Fax:
Practice Address - Street 1:3130 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-0018
Practice Address - Country:US
Practice Address - Phone:715-735-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51658-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI51658-20OtherWI LICENSE
WI51658-20OtherWI LICENSE