Healthcare Provider Details

I. General information

NPI: 1861753725
Provider Name (Legal Business Name): REZA KAHNAMOUEI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 02/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43301 COMMONS DR
CLINTON TWP MI
48038-1109
US

IV. Provider business mailing address

1401 KIRKWAY RD
BLOOMFIELD HILLS MI
48302-1318
US

V. Phone/Fax

Practice location:
  • Phone: 586-745-3006
  • Fax: 586-935-3762
Mailing address:
  • Phone: 313-622-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301090040
License Number StateMI

VIII. Authorized Official

Name: DR. MOHAMMADREZA KAHNAMOUEI
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 313-622-0582