Organization
ABYSSININ LOVEKNOT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MALIK FUQUA (OWNER)
(248) 968-6899
Entity
Organization
Contact information
Practice address
21700 GREENFIELD RD, 215B, OAK PARK, MI 48237-2581
(248) 968-6899
Mailing address
21700 GREENFIELD RD, 215B, OAK PARK, MI 48237-2581
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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