Healthcare Provider Details

I. General information

NPI: 1881179752
Provider Name (Legal Business Name): MUAD MOHAMED A SULEIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

7394 CENTRAL ST APT 2
WESTLAND MI
48185-2552
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDL13777
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: