Healthcare Provider Details

I. General information

NPI: 1003084492
Provider Name (Legal Business Name): MUKSI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26411 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4528
US

IV. Provider business mailing address

3404 WARWICK DR
ROCHESTER HILLS MI
48309-4707
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-8195
  • Fax: 248-552-8537
Mailing address:
  • Phone: 734-462-0340
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301061568
License Number StateMI

VIII. Authorized Official

Name: MUNZER SAMAD
Title or Position: SOLE MEMBER
Credential: MD
Phone: 248-935-7976