Provider Demographics
NPI:1194481333
Name:YOUR AT HOME DOCTOR P.C.
Entity type:Organization
Organization Name:YOUR AT HOME DOCTOR P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-661-5939
Mailing Address - Street 1:5121 FLUSHING RD STE C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2571
Mailing Address - Country:US
Mailing Address - Phone:734-778-5875
Mailing Address - Fax:
Practice Address - Street 1:5121 FLUSHING RD STE C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2571
Practice Address - Country:US
Practice Address - Phone:734-778-5875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty