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General NPI Number Information
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NPI Number | 1548125313
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Entity Type | Organization
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Legal Business Name | MEDICAL HAVEN PLLC
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 2851 ORCHARD LAKE RD # 605
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City | KEEGO HARBOR
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State | MI
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Zip | 48320-9991
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Country | US
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Telephone | 313-858-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 ORCHARD LAKE RD # 605
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City | KEEGO HARBOR
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State | MI
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Zip | 48320-9991
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MOHAMMAD M BALLOUT
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Credential | MD
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Telephone | 313-858-0374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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