Healthcare Provider Details

I. General information

NPI: 1699691766
Provider Name (Legal Business Name): M. MOHANAD AL HENNAWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COREWELL HEALTH DEARBORN HOSPITAL 18101 OAKWOOD BLVD
DEARBORN MI
48124
US

IV. Provider business mailing address

COREWELL HEALTH DEARBORN HOSPITAL 18101 OAKWOOD BLVD
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7000
  • Fax: 313-791-4663
Mailing address:
  • Phone: 313-593-7000
  • Fax: 313-791-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: