Healthcare Provider Details

I. General information

NPI: 1689207367
Provider Name (Legal Business Name): MALEK RAMMOUNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

19853 OUTER DR STE 110
DEARBORN MI
48124-2044
US

V. Phone/Fax

Practice location:
  • Phone: 313-229-1245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR550579577128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: