Healthcare Provider Details

I. General information

NPI: 1285529578
Provider Name (Legal Business Name): NADINE MOKH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLANE BLVD STE 1200E
DEARBORN MI
48126-4244
US

IV. Provider business mailing address

4643 ACADEMY ST
DEARBORN HEIGHTS MI
48125-2207
US

V. Phone/Fax

Practice location:
  • Phone: 734-291-2173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: