Healthcare Provider Details

I. General information

NPI: 1114506532
Provider Name (Legal Business Name): AMIR MOHAMMAD DANESHVAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD
DETROIT MI
48236-2167
US

IV. Provider business mailing address

1 FORD PL # 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4850
  • Fax: 313-876-1305
Mailing address:
  • Phone: 800-999-5829
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301517687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: