Healthcare Provider Details

I. General information

NPI: 1316068653
Provider Name (Legal Business Name): MOUHAMMED JOUMAA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25910 KELLY RD SUITE B
ROSEVILLE MI
48066-4466
US

IV. Provider business mailing address

50505 SCHOENHERR RD SUITE 320
SHELBY TOWNSHIP MI
48315-3140
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-3366
  • Fax: 586-772-3355
Mailing address:
  • Phone: 586-580-3062
  • Fax: 586-580-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301074133
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.139721
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301074133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: