Healthcare Provider Details

I. General information

NPI: 1790655496
Provider Name (Legal Business Name): MOHSIN GELEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10144 VERNOR HWY
DEARBORN MI
48120-1515
US

IV. Provider business mailing address

5656 MIDDLESEX ST
DEARBORN MI
48126-2111
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-6059
  • Fax:
Mailing address:
  • Phone: 313-645-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4704352694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: