Provider Demographics
NPI:1144997826
Name:HAMOOD, ENTASER
Entity type:Individual
Prefix:
First Name:ENTASER
Middle Name:
Last Name:HAMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20290 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2002
Mailing Address - Country:US
Mailing Address - Phone:248-987-1250
Mailing Address - Fax:
Practice Address - Street 1:7742 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1159
Practice Address - Country:US
Practice Address - Phone:313-429-3195
Practice Address - Fax:313-484-2255
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant