Healthcare Provider Details

I. General information

NPI: 1679052112
Provider Name (Legal Business Name): MUHAMMED ERSHAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 9C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST # 9C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3000
  • Fax:
Mailing address:
  • Phone: 267-584-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberMT216312
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351047130
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number320093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: