Provider Demographics
NPI:1427678440
Name:MICHIGAN TELEMED PLLC
Entity type:Organization
Organization Name:MICHIGAN TELEMED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ZUHAIR
Authorized Official - Last Name:AL-SHARABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-729-7727
Mailing Address - Street 1:3709 EDENDERRY DR.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5120
Mailing Address - Country:US
Mailing Address - Phone:313-729-7727
Mailing Address - Fax:313-789-1738
Practice Address - Street 1:3709 EDENDERRY DR.
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5120
Practice Address - Country:US
Practice Address - Phone:313-729-7727
Practice Address - Fax:313-789-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114005576Medicaid