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General NPI Number Information
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NPI Number | 1598993438
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Entity Type | Individual
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Provider Name | WAZIM MOHAMED M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST STE 8A & 8B
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4275
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Fax | 313-745-4468
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Provider Business Mailing Address
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Address Line | 1560 E MAPLE RD SUITE 400-CREDENTIALING DEPT
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City | TROY
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State | MI
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Zip | 48083-1138
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Country | US
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Telephone | 313-745-4275
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Fax | 313-745-4468
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301092204
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 4301092204
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 4301092204
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License Number State | MI
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