Healthcare Provider Details

I. General information

NPI: 1669362158
Provider Name (Legal Business Name): AMMAR MUSLEH MUHSIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 9 MILE RD
HAZEL PARK MI
48030-1854
US

IV. Provider business mailing address

2598 GENESYS PKWY
GRAND BLANC MI
48439-8069
US

V. Phone/Fax

Practice location:
  • Phone: 313-213-2899
  • Fax:
Mailing address:
  • Phone: 313-213-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: