MEDICARE: MR. SULTAN MAHMOOD RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501004932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F35778	OTHER	MI	BCBSM PHYSICAL THERAPY
2	383456889	OTHER	MI	PPOM PHYSICAL THERAPY

General Provider Information

NPI Number	:	1164642302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SULTAN MAHMOOD RPT

Provider Business Mailing Address
First Line	:	56187 NICKELBY SOUTH
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316
Country	:	US
Telephone Number	:	248-542-7440
Fax Number	:	248-545-4327

Provider Business Practice Location Address
First Line	:	28373 DEQUINDRE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3003
Country	:	US
Telephone Number	:	248-542-7440
Fax Number	:	248-545-4327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	10/01/2024

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