Healthcare Provider Details

I. General information

NPI: 1417873902
Provider Name (Legal Business Name): MAHER GHANEM MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 E BIG BEAVER RD STE 104
TROY MI
48083-2053
US

IV. Provider business mailing address

1020 CHARTER DR STE B
FLINT MI
48532-3584
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-8300
  • Fax:
Mailing address:
  • Phone: 810-733-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHER GHANEM
Title or Position: PROVIDER
Credential: MD
Phone: 313-618-2948