Healthcare Provider Details

I. General information

NPI: 1790256980
Provider Name (Legal Business Name): FAIZA MASOUD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33330 PALMER RD
WESTLAND MI
48186-5529
US

IV. Provider business mailing address

26541 ANCHORAGE CT
NOVI MI
48374-2125
US

V. Phone/Fax

Practice location:
  • Phone: 248-739-0283
  • Fax: 734-729-9435
Mailing address:
  • Phone: 248-739-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAIZA MASOUD
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 248-739-0283