Healthcare Provider Details

I. General information

NPI: 1548299464
Provider Name (Legal Business Name): MOHAMAD ARJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/02/2023
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N SAGINAW ST STE 104A
LAPEER MI
48446-7627
US

IV. Provider business mailing address

1739 N SAGINAW ST STE 104A
LAPEER MI
48446-7627
US

V. Phone/Fax

Practice location:
  • Phone: 810-305-0061
  • Fax: 810-305-3319
Mailing address:
  • Phone: 810-305-0061
  • Fax: 810-305-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301089537
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301089537
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19513
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301089537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: