Provider Demographics
NPI:1548550643
Name:MOHAMMED M. OBEID, DO PC
Entity type:Organization
Organization Name:MOHAMMED M. OBEID, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:MUAZ
Authorized Official - Last Name:OBEID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-851-2543
Mailing Address - Street 1:14716 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1347
Mailing Address - Country:US
Mailing Address - Phone:313-584-0018
Mailing Address - Fax:313-581-9091
Practice Address - Street 1:14716 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1347
Practice Address - Country:US
Practice Address - Phone:313-584-0018
Practice Address - Fax:313-581-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII21678Medicare UPIN