Healthcare Provider Details

I. General information

NPI: 1922665314
Provider Name (Legal Business Name): MOHAMAD MAKKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 E 12 MILE RD
WARREN MI
48093-3570
US

IV. Provider business mailing address

6915 OAKMAN BLVD
DEARBORN MI
48126-1894
US

V. Phone/Fax

Practice location:
  • Phone: 586-576-4140
  • Fax:
Mailing address:
  • Phone: 313-384-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: