Healthcare Provider Details

I. General information

NPI: 1871177964
Provider Name (Legal Business Name): MOHSIN AHMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11885 E 12 MILE RD STE 200B
WARREN MI
48093-3469
US

IV. Provider business mailing address

321 W LAFAYETTE BLVD UNIT 903
DETROIT MI
48226-2728
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-6630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301518441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: