Individual
DR. MAMOUN DABBAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28800 RYAN RD, STE 320, WARREN, MI 48092-4272
(586) 582-0500
(586) 620-8113
Mailing address
28800 RYAN RD, STE 320, WARREN, MI 48092-4272
(586) 582-0500
(586) 620-8113
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301045473
MI
2084P0804X
Child & Adolescent Psychiatry Physician
4301045473
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2606315452
BLUE CROSS BLUE SHIELD MI
MI
05
—
2721634
—
MI
Enumeration date
01/11/2007
Last updated
09/08/2014
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