Provider Demographics
NPI:1548299464
Name:ARJA, MOHAMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:ARJA
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 1:1739 N SAGINAW ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-7627
Mailing Address - Country:US
Mailing Address - Phone:810-305-0061
Mailing Address - Fax:810-305-3319
Practice Address - Street 1:1739 N SAGINAW ST STE 104A
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-7627
Practice Address - Country:US
Practice Address - Phone:810-305-0061
Practice Address - Fax:810-305-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089537207R00000X, 261QP2300X, 208D00000X
WV19513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0012776Medicaid
MIMI8595001OtherPTAN
WV0082038000Medicaid
MICV0012776Medicaid