Healthcare Provider Details

I. General information

NPI: 1437053972
Provider Name (Legal Business Name): MAHDI CHARARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUDHUD CHARARA

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SHADY HOLLOW DR
DEARBORN MI
48124-1129
US

IV. Provider business mailing address

23 SHADY HOLLOW DR
DEARBORN MI
48124-1129
US

V. Phone/Fax

Practice location:
  • Phone: 313-229-4297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: