MEDICARE: PULSAR MEDICAL GROUP MD PC

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	207R00000X	Internal Medicine Physician	4301088545	MI

General Provider Information

NPI Number	:	1972918829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULSAR MEDICAL GROUP MD PC

Provider Business Mailing Address
First Line	:	38167 TURNBERRY CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4800
Country	:	US
Telephone Number	:	248-522-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	38167 TURNBERRY CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4800
Country	:	US
Telephone Number	:	248-522-6755
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABU FAZAL SHAIK MOHAMMED
Credential	:	M.D.
Telephone Number	:	248-522-6755

Provider Enumeration Date	:	06/29/2014
Last Update Date	:	06/29/2014

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