Provider Demographics
NPI:1306537485
Name:RADA, MOHAMAD ALI
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:ALI
Last Name:RADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29447 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2319
Mailing Address - Country:US
Mailing Address - Phone:734-525-3246
Mailing Address - Fax:734-525-8534
Practice Address - Street 1:29447 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2319
Practice Address - Country:US
Practice Address - Phone:734-525-3246
Practice Address - Fax:734-525-8534
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI5303045683183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical