Provider Demographics
NPI:1366484206
Name:MOHAMMED, SABAH M (MD)
Entity type:Individual
Prefix:
First Name:SABAH
Middle Name:M
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18263 E 10 MILE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5805
Mailing Address - Country:US
Mailing Address - Phone:586-778-4950
Mailing Address - Fax:586-778-4952
Practice Address - Street 1:18263 E 10 MILE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4950
Practice Address - Fax:586-778-4952
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MI4922589Medicaid
MIN40170083Medicare PIN
MI4922589Medicaid