Healthcare Provider Details

I. General information

NPI: 1023752268
Provider Name (Legal Business Name): NARJIS MUMTAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 WEST GRAND BLVD., HENRY FORD HOSPITAL
DETRIOT MI
48202
US

IV. Provider business mailing address

2799 WEST GRAND BLVD., HENRY FORD HOSPITAL
DETRIOT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8445
  • Fax: 313-916-9434
Mailing address:
  • Phone: 313-916-8445
  • Fax: 313-916-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: