Healthcare Provider Details

I. General information

NPI: 1417064502
Provider Name (Legal Business Name): MASROOR UL HAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20282 MIDDLEBELT RD
LIVONIA MI
48152-2002
US

IV. Provider business mailing address

PO BOX 252361
WEST BLOOMFIELD MI
48325-2361
US

V. Phone/Fax

Practice location:
  • Phone: 248-882-1152
  • Fax:
Mailing address:
  • Phone: 248-719-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301060252
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301060252
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: