Provider Demographics
NPI:1316068653
Name:JOUMAA, MOUHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOUHAMMED
Middle Name:
Last Name:JOUMAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-580-3062
Mailing Address - Fax:586-580-3143
Practice Address - Street 1:25910 KELLY RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4466
Practice Address - Country:US
Practice Address - Phone:586-772-3366
Practice Address - Fax:586-772-3355
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074133207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315023267OtherCONTROLLED SUBSTANCE LICE
MI4301074133OtherPHYSICIAN LICENSE
I74260Medicare UPIN
0N40870008Medicare PIN