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NPI Code Detail

MEDICARE: DR. MOHAMED-IQBAL PASHA ROUF MD

MEDICARE: DR. MOHAMED-IQBAL PASHA ROUF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist Physician4301079037MI
2207R00000XInternal Medicine Physician4301079037MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669471116
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMED-IQBAL PASHA ROUF MD
Provider Business Mailing Address
First Line : 2799 W GRAND BLVD, CFP 417
Second Line :
City : DETROIT
State : MI
Zip : 48202
Country : US
Telephone Number : 313-916-8144
Fax Number : 313-916-4460
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD # 417
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-916-8144
Fax Number : 313-916-4460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 02/21/2024

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