Healthcare Provider Details

I. General information

NPI: 1376168732
Provider Name (Legal Business Name): MEHDI YAVARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date: 01/18/2022
Reactivation Date: 02/02/2022

III. Provider practice location address

22201 MOROSS RD
DETROIT MI
48236
US

IV. Provider business mailing address

22201 MOROSS RD
DETROIT MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7774
  • Fax: 313-343-8747
Mailing address:
  • Phone: 313-343-7774
  • Fax: 313-343-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01096881A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: