Healthcare Provider Details

I. General information

NPI: 1992061592
Provider Name (Legal Business Name): FAIZA MASOUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33330 PALMER RD
WESTLAND MI
48186
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 TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301113466
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301113466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: