Healthcare Provider Details

I. General information

NPI: 1619752748
Provider Name (Legal Business Name): SAJDA MEKHI MUSA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20175 ROGGE ST
DETROIT MI
48234-3032
US

IV. Provider business mailing address

20175 ROGGE ST
DETROIT MI
48234-3032
US

V. Phone/Fax

Practice location:
  • Phone: 313-955-2742
  • Fax:
Mailing address:
  • Phone: 313-955-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: