MEDICARE: DR. MOHAMED AMJAD SOOFI M.D.

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	207Q00000X	Family Medicine Physician	MS049788	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14196B	OTHER	MI	HAP
2	3940001003	OTHER	MI	CIGNA
3	0105801292	OTHER	MI	BLUE CROSS BLUE SHIELD
4	4036635	OTHER	MI	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235149899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED AMJAD SOOFI M.D.

Provider Business Mailing Address
First Line	:	2252 N MONROE ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-4254
Country	:	US
Telephone Number	:	734-241-2726
Fax Number	:	734-241-2744

Provider Business Practice Location Address
First Line	:	2252 N MONROE ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-4254
Country	:	US
Telephone Number	:	734-241-2726
Fax Number	:	734-241-2744

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	02/20/2014

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