Healthcare Provider Details

I. General information

NPI: 1043109275
Provider Name (Legal Business Name): ADRITA NOURIN MOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708-6880
US

IV. Provider business mailing address

5470 CAMERON ELLIS DR APT 108
WESTERVILLE OH
43081-9029
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3000
  • Fax:
Mailing address:
  • Phone: 216-703-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056033
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP136220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: