Healthcare Provider Details

I. General information

NPI: 1699745596
Provider Name (Legal Business Name): HOOMAN AGHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15604 FARMINGTON RD
LIVONIA MI
48154-2852
US

IV. Provider business mailing address

15604 FARMINGTON RD
LIVONIA MI
48154-2852
US

V. Phone/Fax

Practice location:
  • Phone: 734-855-4176
  • Fax: 734-855-4178
Mailing address:
  • Phone: 734-855-4176
  • Fax: 734-855-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberHA079451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: