Healthcare Provider Details

I. General information

NPI: 1982997094
Provider Name (Legal Business Name): MUHAMMAD K MUIZUDDIN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST EMERGENCY MEDICINE DEPARTMENT
WAYNE MI
48184-2405
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING SERVICES
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4042
  • Fax: 734-467-5500
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: