Healthcare Provider Details

I. General information

NPI: 1821042581
Provider Name (Legal Business Name): MOHAMMAD SOBHI ELMENINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 W WARREN AVE
DEARBORN MI
48126-1191
US

IV. Provider business mailing address

10645 W WARREN AVE
DEARBORN MI
48126-8009
US

V. Phone/Fax

Practice location:
  • Phone: 313-945-9393
  • Fax: 313-945-9122
Mailing address:
  • Phone: 313-945-9393
  • Fax: 313-945-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301065777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: