Provider Demographics
NPI:1699745596
Name:AGHA, HOOMAN (MD)
Entity type:Individual
Prefix:DR
First Name:HOOMAN
Middle Name:
Last Name:AGHA
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 1:15604 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2852
Mailing Address - Country:US
Mailing Address - Phone:734-855-4176
Mailing Address - Fax:734-855-4178
Practice Address - Street 1:15604 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2852
Practice Address - Country:US
Practice Address - Phone:734-855-4176
Practice Address - Fax:734-855-4178
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHA079451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4415881Medicaid
MION31880004Medicare ID - Type Unspecified
MI4415881Medicaid