Provider Demographics
NPI:1588893762
Name:MAHMOOD, NAZNIN (MD)
Entity type:Individual
Prefix:
First Name:NAZNIN
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, K-11
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:773-375-2170
Mailing Address - Fax:248-325-3125
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, K-11
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:773-375-2170
Practice Address - Fax:248-325-3125
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010861612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology