Healthcare Provider Details

I. General information

NPI: 1669471116
Provider Name (Legal Business Name): MOHAMED-IQBAL PASHA ROUF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD # 417
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD, CFP 417
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax: 313-916-4460
Mailing address:
  • Phone: 313-916-8144
  • Fax: 313-916-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301079037
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301079037
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: