Provider Demographics
NPI:1447377163
Name:MOHAMED, ANWAR N (MS, MD)
Entity type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:N
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4727 SAINT ANTOINE ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1461
Mailing Address - Country:US
Mailing Address - Phone:313-745-9672
Mailing Address - Fax:313-966-0687
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 411
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-745-9672
Practice Address - Fax:313-966-0687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory