Healthcare Provider Details

I. General information

NPI: 1962427260
Provider Name (Legal Business Name): MAHIR DARRAR ELDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 510
DETROIT MI
48201-2021
US

IV. Provider business mailing address

22725 ALEXANDRINE ST
DEARBORN MI
48124-1081
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax: 313-993-2563
Mailing address:
  • Phone: 313-563-3609
  • Fax: 313-563-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301073824
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: