Healthcare Provider Details

I. General information

NPI: 1396676656
Provider Name (Legal Business Name): MUNNA AHMAD HAZIME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD # 126
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

5632 APPOLINE ST
DEARBORN MI
48126-2316
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2582
  • Fax:
Mailing address:
  • Phone: 313-614-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4351056756
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4351056756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: