Healthcare Provider Details

I. General information

NPI: 1417880469
Provider Name (Legal Business Name): MOHAMED MASHRAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 TELEGRAPH RD STE 210
TAYLOR MI
48180-6851
US

IV. Provider business mailing address

2758 SYRACUSE ST
DEARBORN MI
48124-3302
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-3094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number26144105507
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: