Healthcare Provider Details

I. General information

NPI: 1396728507
Provider Name (Legal Business Name): FEROZE A MOMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MONROE ST STE 203
DEARBORN MI
48124-2926
US

IV. Provider business mailing address

13530 MICHIGAN AVE STE 242
DEARBORN MI
48126-3575
US

V. Phone/Fax

Practice location:
  • Phone: 313-388-6299
  • Fax: 313-388-6328
Mailing address:
  • Phone: 313-388-6299
  • Fax: 313-388-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301051771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: