Healthcare Provider Details

I. General information

NPI: 1750749974
Provider Name (Legal Business Name): ZAKWAN MAHJOUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

811 SOUTH BLVD E. STE 105
ROCHESTER HILLS MI
48307-5303
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 TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301067249
License Number StateMI

VIII. Authorized Official

Name: MS. TERRI WHITE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-710-1000