Healthcare Provider Details

I. General information

NPI: 1962404517
Provider Name (Legal Business Name): MOHAMMED ALKHATEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 MAIN ST STE 3
MARLETTE MI
48453-1100
US

IV. Provider business mailing address

2750 MAIN ST STE 3
MARLETTE MI
48453-1100
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-4023
  • Fax: 989-635-5297
Mailing address:
  • Phone: 989-635-4023
  • Fax: 989-635-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35074589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: