Healthcare Provider Details

I. General information

NPI: 1578524245
Provider Name (Legal Business Name): MOHAMMAD NAVAI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 N PONTIAC TRL
WALLED LAKE MI
48390-3157
US

IV. Provider business mailing address

1935 N PONTIAC TRL
WALLED LAKE MI
48390-3157
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-7444
  • Fax: 734-459-7755
Mailing address:
  • Phone: 734-459-7444
  • Fax: 734-459-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMN039162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: