Healthcare Provider Details

I. General information

NPI: 1861015968
Provider Name (Legal Business Name): MOHAMED MURAD MUSHEINESH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MONROE ST
DEARBORN MI
48124-2912
US

IV. Provider business mailing address

1637 MONROE ST
DEARBORN MI
48124-2912
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-3347
  • Fax: 313-254-2921
Mailing address:
  • Phone: 313-551-3347
  • Fax: 313-254-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101029460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: