Healthcare Provider Details

I. General information

NPI: 1780511451
Provider Name (Legal Business Name): MAHMOOD MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 HAGGERTY RD
VAN BUREN TOWNSHIP MI
48111-3443
US

IV. Provider business mailing address

9850 HAGGERTY RD
VAN BUREN TOWNSHIP MI
48111-3443
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-3080
  • Fax: 734-699-3946
Mailing address:
  • Phone: 734-699-3080
  • Fax: 734-699-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ALI MAHMOOD
Title or Position: CEO
Credential: MD
Phone: 734-699-3080