Healthcare Provider Details

I. General information

NPI: 1316916729
Provider Name (Legal Business Name): ZAKWAN MAHJOUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E SOUTH BLVD STE 105
ROCHESTER HILLS MI
48307-5303
US

IV. Provider business mailing address

811 SOUTH BLVD E STE 105
ROCHESTER HILLS MI
48307-5359
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-1000
  • Fax: 248-710-1011
Mailing address:
  • Phone: 248-710-1000
  • Fax: 248-710-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301067249
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301067249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: