1295281582 NPI number — MOHAMED MAKKI

Table of content: MOHAMED MAKKI (NPI 1295281582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295281582 NPI number — MOHAMED MAKKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKKI
Provider First Name:
MOHAMED
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295281582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26329 SIMONE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-989-3036
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20905 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 300 M
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-234-8717
Provider Business Practice Location Address Fax Number:
248-809-6852
Provider Enumeration Date:
08/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  465558663 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com