Provider Demographics
NPI:1316916729
Name:MAHJOUB, ZAKWAN (MD)
Entity type:Individual
Prefix:
First Name:ZAKWAN
Middle Name:
Last Name:MAHJOUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SOUTH BLVD E STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5359
Mailing Address - Country:US
Mailing Address - Phone:248-710-1000
Mailing Address - Fax:248-710-1011
Practice Address - Street 1:811 E SOUTH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5303
Practice Address - Country:US
Practice Address - Phone:248-710-1000
Practice Address - Fax:248-710-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067249207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104254136Medicaid
MIF32288OtherHAP
MI700F37550OtherBCBSM
MIF32288OtherHAP
MIM89900007Medicare PIN