Healthcare Provider Details

I. General information

NPI: 1104073766
Provider Name (Legal Business Name): MOHAMMAD AHMAD ALQARQAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL
DETROIT MI
48202-2608
US

IV. Provider business mailing address

1350 W BETHUNE ST HENRYFORD GUEST APARTMENTS , APT 1007
DETROIT MI
48202-2600
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2600
  • Fax:
Mailing address:
  • Phone: 248-808-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301091996
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number77254
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301091996
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: