=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912227455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED ABBAS HUSSAIN MOOSAVI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2010
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8152 25 MILE RD STE B
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-844-8281
-----------------------------------------------------
Fax | 248-844-9105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8152 25 MILE RD STE B
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-844-8281
-----------------------------------------------------
Fax | 248-844-9105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 4301096741
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------