Healthcare Provider Details

I. General information

NPI: 1124911086
Provider Name (Legal Business Name): MUHAMMAD SHAIR ISMAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 08/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD (COREWELL HEALTH)
DEARBORN MI
48124
US

IV. Provider business mailing address

18101 OAKWOOD BLVD (COREWELL HEALTH)
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2578
  • Fax:
Mailing address:
  • Phone: 313-436-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351054578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: