Healthcare Provider Details

I. General information

NPI: 1306413901
Provider Name (Legal Business Name): FATEMA MIRZA HAMMAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GME OFFICE 4201 ST. ANTOINE, UHC-9C DETROIT MEDICAL CENTER
DETROIT MI
48201
US

IV. Provider business mailing address

GME OFFICE 4201 ST. ANTOINE, UHC-9C DETROIT MEDICAL CENTER
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-0945
  • Fax: 313-993-7118
Mailing address:
  • Phone: 313-966-0945
  • Fax: 313-993-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: