Healthcare Provider Details

I. General information

NPI: 1326489212
Provider Name (Legal Business Name): CYNTHIA D MUHAMMAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 W 11 MILE RD SUITE 200
SOUTHFIELD MI
48076-3843
US

IV. Provider business mailing address

22043 IRENE
BROWNSTOWN TWP MI
48183-1441
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-2000
  • Fax: 248-352-8800
Mailing address:
  • Phone: 313-204-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704218487
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704218487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: