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General NPI Number Information
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NPI Number | 1699085951
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Entity Type | Organization
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Legal Business Name | ARTHRITIS & RHEUMATISM, PLLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 1623 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2303
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Country | US
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Telephone | 734-282-7000
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Fax | 734-282-7390
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Provider Business Mailing Address
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Address Line | 1623 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2303
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Country | US
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Telephone | 734-282-7000
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Fax | 734-282-7390
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Authorized Official
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Title or Position | DIRECTOR
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Name | MUSTAPHA MALLAH
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Credential | M.D.
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Telephone | 734-389-7167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 4301081080
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License Number State | MI
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