Healthcare Provider Details

I. General information

NPI: 1639010648
Provider Name (Legal Business Name): JANA MOUKAHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3015
  • Fax: 248-849-2078
Mailing address:
  • Phone: 248-849-3015
  • Fax: 248-849-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351055940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: