MEDICARE: MOUSTARAH HEALTH PLLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1760073381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUSTARAH HEALTH PLLC

Provider Business Mailing Address
First Line	:	PO BOX 724
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48121-0724
Country	:	US
Telephone Number	:	989-980-4995
Fax Number	:

Provider Business Practice Location Address
First Line	:	43494 WOODWARD AVE STE 202
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5054
Country	:	US
Telephone Number	:	989-980-4995
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/SURGEON
Name	:	DR. FADY MOUSTARAH
Credential	:	MD, MPH
Telephone Number	:	989-980-4995

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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Directions to “MOUSTARAH HEALTH PLLC ” Practice Location

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