Healthcare Provider Details

I. General information

NPI: 1417534959
Provider Name (Legal Business Name): MOAZ SINAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CENTER RD BLDG B
BURTON MI
48509-1731
US

IV. Provider business mailing address

64 MEDICAL CENTER DR
MORGANTOWN WV
26505-3409
US

V. Phone/Fax

Practice location:
  • Phone: 810-742-0225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301518282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: