Healthcare Provider Details

I. General information

NPI: 1487570461
Provider Name (Legal Business Name): MOHAMMAD MAHDI DEHBOZORGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD.
LIVONIA MI
48154
US

IV. Provider business mailing address

149 ASHLEY ROAD
BEACONSFIELD QUEBEC
H9W1K7
CA

V. Phone/Fax

Practice location:
  • Phone: 734-655-2736
  • Fax: 734-655-8430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: